Masui. The Japanese journal of anesthesiology
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Anesthestic management with prolonged one-lung ventilation is difficult, especially when the patient continues smoking habit. Here, we report a successful one-lung ventilation and protection with combined use of double-lumen endotracheal tube and bronchial blocker. A 68-year-old man (height 153 cm; weight, 45 kg) was scheduled for simultaneous surgery of right lobectomy and esophagectomy. ⋯ Furthermore, there was no visible blood inflow in the left bronchus. We could protect the ventilated lung with double cuff, i. e. bronchial cuff of DLT in the left bronchus and BB cuff in the right bronchus. Simultaneous operation was uneventfully performed and no oxygenation or ventilation trouble was observed during the operation.
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Epidural analgesia or paravertebral block is widely used in postoperative analgesia for video-assisted thoracic surgery (VATS). We investigated the efficacy of the continuous intravenous infuion of fentanyl combined with intercostal nerve block, in comparison with the continuous epidural analgesia. ⋯ Continuous intravenous infusion of fentanyl combined with intercostal nerve block is effective in the postoperative analgesia for VATS, as well as continuous epidural analgesia.
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The Pentax AWS-s200 (Hoya, Japan : s-200) is a new videolaryngoscope. Its weight is 190 g, and it is lighter than the original AWS (AWS-s100L: s-100). It has a USB port, and its screen is wider and clearer than the s-100. ⋯ We used the s-200 in 20 patients, and could see a full view of the glottis, and tracheal intubation was successful in all patients. But tracheal intubation was not smooth in 10 of 20 patients, mainly because the tube impacted the right arytenoid. We felt the target mark of the s-200 may be incorrectly positioned.
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We report a case of vasoplegic syndrome (VS) after aortic valve replacement in a 65 year old male with aortic stenosis. The patient developed hypotension after separation from cardiopulmonary bypass (CPB). Transesophageal echocardiography revealed well-maintained cardiac function and normal prosthetic valve function. ⋯ Hypotension at the time of separation from CPB can be due to multiple factors. Despite an incidence rate of 10%, little is known about VS. We hope that, in future, tailored therapeutic protocols for VS will be developed.
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Examination of the literature suggests that the incidence of aspiration pneumonia in the perioperative period is relatively infrequent. Since Mendelson's report of aspiration pneumonitis in 1946, the factors that contribute to the likelihood of aspiration have been identified, and numerous attempts for preventions for regurgitation or pulmonary aspiration have been made. ⋯ Second generation supraglottic airways may not reduce the risk of regurgitation, but may reduce the chance of aspiration if the mask position is correct and drain tube works well. Because the mortality and morbidity of aspiration pneumonia remain relatively high, the preoperative risk evaluation is very important to avoid regurgitation or aspiration.