Masui. The Japanese journal of anesthesiology
-
We report a case of sudden head-tilt difficulty after induction of general anesthesia which was postoperatively diagnosed as ossification of the posterior longitudinal ligament. A 42-year-old man weighing 115 kg was scheduled for emergent laparoscopic appendectomy for acute appendicitis. ⋯ Following mask ventilation with jaw-thrust maneuver, we successfully performed tracheal intubation using the Pentax-AWS Airwayscope. After surgery, he was diagnosed with ossification of the posterior longitudinal ligament by an orthopedist.
-
The laryngeal tube (LT ; Smiths Medical, Minnesota, U. S. A) is an inflatable supraglottic device for emergency airway management such as during chest compression, the instability after insertion remains a problem. ⋯ A fixation neck tape may be useful in stabilizing the inserted position of LT during cardiopulmonary resuscitation.
-
Intraoperative neurophysiological monitoring has been increasingly utilized for many neurosurgical procedures as well as for spine and aortic surgery. The recent advances in monitoring devices and anesthesia techniques have improved the reliability and accuracy of intraoperative neurological monitoring. In this issue, we review the basic principle, methods, and clinical application of several modalities of neurological monitoring to detect neural tissue ischemia and the direct physical injury to the specific neural pathway during surgical procedures. ⋯ Evidence for the efficacy of the monitoring varied with surgical procedures, but has been well validated in some procedures. Anesthesiologists can contribute to the reliability and efficacy of neurophysiological monitoring by maintaining good physiological homeostasis and stable levels of anesthesia during the surgical procedure. With appropriate knowledge and experience, the anesthesiologist should work together with the neuromonitoring staff and surgeon to ensure neurological safety for the patient during and after surgery.
-
A 75-year-old woman suffering from respiratory difficulty was diagnosed with severe tracheal stenosis due o malignant thyroid cancer. She was scheduled for an mergent tracheotomy, but preoperative computed omography revealed severe tracheal stenosis below he glottis due to thyroid cancer invasion. ⋯ Successful tracheal intubation which avoided damage to the tumor was achieved while maintaining spontaneous ventilation. The air-Q intubating laryngeal airway was useful in this setting of severe tracheal stenosis due to thyroid cancer just under the glottis.
-
Here, we report successful anesthetic management of posterior cervical spinal fusion utilizing block of the frontal nerve, the greater occipital nerve, and the superficial cervical plexus in a patient with athetoid cerebral palsy. A 69-year-old woman (height 157 cm; weight 33 kg) with athetoid cerebral palsy was scheduled to undergo posterior cervical spinal fusion for cervical spondylotic myelopathy. After induction of general anesthesia, we performed tracheal intubation using the Pentax-AWS Airwayscope with a thin Intlock. ⋯ Continuous administration of dexmedetomidine was started during operation. Following surgery, smooth spontaneous ventilation was observed following uneventful extubation. No significant pain and no athetoid movement were observed under continuous administration of dexmedetomidine.