Masui. The Japanese journal of anesthesiology
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A patient with medication resistant schizophrenia underwent modified electroconvulsive therapy (12 sessions). Propofol was chosen as a hypnotic agent and the adjustment of its dose and stimulus intensity was attempted. ⋯ This allowed to reach the seizure adequacy during the next and the four subsequent sessions. Although from the tenth session on, adequate seizures could no longer be induced (possibly due to the development of resistance to propofol), the patient's symptoms showed improvement after completion of all 12 sessions.
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Case Reports
[Use of a New Video-laryngoscope (McGRATH® X-blade™) in Patients with Difficult Airways].
We describe the use of a new video-laryngoscope (McGRATH® X-blade™, X-blade) in patients with difficult airways. We report four cases of difficult and failed tracheal intubation using a conventional Machintosh laryngoscope and McGRATH® MAC in which tracheal intubation was accomplished swiftly and easily using a newly designed videolaryngoscope, the X-blade. ⋯ X-blade also provided a good view of glottic opening in a patient with obesity. We believe that X-blade is useful in patients with difficult airways.
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Case Reports
[Combined Use of a Videolaryngoscope and a Transilluminating Device for Intubation with Two Difficult Airways].
Videolaryngoscope is useful in patients with difficult airways, but it may not be in some patients. We report the use of a lighted stylet to facilitate tracheal intubation in 2 patients in whom laryngoscopy with a videolaryngoscope was difficult. Case 1: A 52-year-old female with loose teeth and lockjaw presented for a scoliosis surgery under general anesthesia. ⋯ Combined use of the Trachilight™ with the GVL, facilitated tracheal intubation. The Trachilight™ is a recognized aid to facilitate trachal intubation but the device is now commercially not available. Neverthless, we believe that a lighted stylet is potentially useful for tracheal intubation when the view of the glottis with a videolaryngoscopy is not ideal.
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A 74-year-old female patient underwent a coil embolization for an unruptured cerebral aneurysm. A routine anesthetic protocol was devised as there was no risk of a difficult airway. ⋯ We changed the stylet to a Parker Flex-IT™ Stylet (Parker Medical, CO, USA), which can be freely curved by pushing the sum button on the top of the stylet. As a result, easy intubation was possible, and the DLT was maneuvered at a proper angle while examining the vocal cords by using the Parker Flex-IT™ Stylet In conclusion, when a McGRATH® MAC laryngoscope cannot be operated freely in the oral cavity owing to a limited oral opening, we can instead intubate easily and effectively by using a combination of a Parker Flex-IT™ Stylet and the McGRATH® MAC video laryngoscope.
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Non-invasive positive pressure ventilation (NPPV) reduces the incidences of ventilator-associated pneumonia, the duration of ICU stay and the mortality rate compared with conventional respiratory management of the patients with acute respiratory failure (ARF). Recently, helmet NPPV equipment became available. Because of the high tolerability, the helmet seems to be the best NPPV interface when prolonged and continuous assistance is needed. In this study, we analyzed several factors related to failure of helmet NPPV in ARF patients in intensive care unit (ICU), retrospectively. ⋯ Helmet NPPV improved oxygenation in ARF patients immediately after induction of NPPV. Although there were no significant predictable parameters of unsuccessful NPPV before induction of NPPV, a lot of excretion of sputum might be suggested as a risk factor.