Masui. The Japanese journal of anesthesiology
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In order to secure airway during awake craniotomy, we used i-gel to perform positive-pressure ventilation in 7 patients for their anesthetic management. During removal of a tumor around the motor speech center, anesthetic management including asleep-awake-asleep technique was applied for speech testing. ⋯ Leakage around i-gel, and its differences between inspiration and expiration were negligible, while the tidal volume was adequate. We conclude that i-gel is useful for anesthetic management for awake craniotomy procedure for both securing airway and ventilation.
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We report a case of successful one-lung ventilation with a spiral-tipped double lumen tube for resection and reconstruction of the tracheal bifurcation. A 71-year-old woman with lung cancer developed its invasion to the right bronchus near the tracheal bifurcation. Right lung total pneumonectomy or reconstruction with resection of the tracheal bifurcation was planned. ⋯ The tracheal tube was exchanged with a spiral-tipped double lumen tube under bronchofiberscopy and one-lung ventilation was achieved. Total pneumonectomy and reconstruction of the tracheal bifurcation proceeded uneventfully. One-lung ventilation with a spiral-tipped double lumen tube may be useful in tumor resection that involves distorted anatomy, such as at tracheal bifurcation.
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We present a case of anticipated difficult airway with severe rheumatoid arthritis in which intubation with fiberoptic bronchoscope (FOB) assisted by Pentax-AWS Airwayscope with the thin Intlock (AWS T) was effective. A 69-year-old woman was scheduled to undergo laparoscopic cholecystectomy for acute cholecystitis in a previous hospital. Tracheal intubation with Glidescope or nasal intubation was unsuccessful and abandoned due to mucosal injury and bleeding. ⋯ We planned to perform tracheal intubation preserving spontaneous breathing under intravenous administration of dexmedetomidine and fentanyl. We could visualize the epiglottis, but could not set the target mark to the invisible glottis with AWS-T. Finally, we could accomplish uneventful tracheal intubation with FOB along with the Intlock's guides of AWS-T.
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Case Reports
[Awake insertion of i-gel under dexmedetomidine sedation in a patient with severe obstructive sleep apnea syndrome].
We report a successful awake insertion of the i-gel supraglottic airway device under dexmedetomidine (DEX) sedation in a patient with severe obstructive sleep apnea syndrome and symptomatic angina. A 71-year-old man was scheduled for open stoma closure under general anesthesia. Given the patient's history of difficult mask ventilation during anesthesia for resection of rectal cancer, we decided to perform awake i-gel insertion under DEX sedation and regional anesthesia with lidocaine. ⋯ We also performed transversus abdominis plane block and rectus sheath block with ropivacaine, as severe respiratory suppression due to continuous intravenous fentanyl infusion had been observed in the previous operation. No vital sign change or respiratory suppression was noted upon recovery from general anesthesia. Awake insertion of a supraglottic airway device, such as i-gel, under DEX sedation can be effective for airway management in patients with severe obstructive sleep apnea syndrome.
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Much evidence has been accumulated on the cerebral mechanisms of pain perception owing to rapid and diverse development in magnetic resonance imaging and its analysis techniques over the last decades. In addition to pain-evoked cerebral activities, our knowledge now extends into chronic pain-associated alterations in cerebral connectivity over networks and in gray matter density, which characterize cerebral steady-state pathological properties underlying chronic pain conditions. A dynamic cerebral model for chronification of pain is presented, in which a bottom-up nociception via the lateral system leads to a reactive, top-down hyperactivity of the medial system, and eventually to both functional and anatomical degeneration of pain modulatory mechanisms and reward systems. All such biomarkers of "chronic pain brain" revealed by neuroimaging will hopefully help us in diagnosis of chronic pain and evaluation of therapeutics for each patient on an outpatient basis.