Masui. The Japanese journal of anesthesiology
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Clinical Trial
[Comprehensive evaluation of the effect of triazolam on amnesia during the preoperative period].
Triazolam reportedly has greater amnesic potential than other benzodiazepines. The present study was designed to investigate whether this amnesic potential can be applied to surgical patients as premedication, thus relieving them from postoperatively remembering preoperative fears of anesthesia and surgery. ⋯ The use of triazolam as premedication produced a high incidence of amnesia for preoperative events without causing respiratory depression. Triazolam appears to be a useful premedicant for surgical patients who wish to have no memory at the operating room.
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We report a case of awake intubation utilizing Pentax-AWS Airwayscope in semi-sitting position. A 74-year-old man with myasthenia gravis and cervical disc hernia was scheduled for distal gastrectomy under general anesthesia. ⋯ With fentanyl bolus administration and lidocaine spray for laryngotracheal anesthesia, we performed awake intubation in semi-sitting position with AWS from cranial side. The patient did not buck during intubation and no hemodynamic change was observed.
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Here we report an anesthetic management of a 74-year-old man with gastric cancer and severe chronic obstructive pulmonary disease (COPD) undergoing endoscopic submucosal dissection (ESD). We maintained spontaneous breathing during ESD under monitored anesthesia care with dexmedetomidine (DEX). ESD lasted 5.5 hours with sufficient analgesia, and he required no airway management with the exception of supplemental mask oxygen during the procedures. ⋯ It should be used judiciously, and understanding the potential adverse effects and how to treat them is of paramount importance. However, with vigilant monitoring of blood pressure, heart rate, and level of consciousness during the ESD, it can be administered safely, thus lessening the anesthetic requirements and possibly improving the surgical outcome of the high risk patients. Especially, patients with severe COPD have demonstrated an increased risk for oxygen desaturation following general anesthesia, and to avoid this complication, spontaneous breathing sedation with DEX during ESD is one of the suitable management methods for COPD patients.
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One-lung ventilation and lung isolation are frequently required in thoracic surgery. In clinical practice, lung isolation is achieved by use of a double-lumen endotracheal tube and a bronchial blocker. A novel bagel shaped bronchial blocker, the Fuggiano's bronchial blocker, has been designed to prevent displacement of the blocker from its position in the bronchus. In this study, we evaluated the clinical performance of the Fuggiano's bronchial blocker for the lung isolation. ⋯ We conclude that, for routine use, the Fuggiano's bronchial blocker is preferable to achieve a lung isolation because of its facility in placement and a better quality of lung deflation. Fuggiano's bronchial blocker may be an alternative airway device for one-lung ventilation, and further work is required.
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Case Reports
[Acute pulmonary edema in adult caused by tonsillar hypertrophy following removal of laryngeal mask airway].
Negative pressure pulmonary edema (NPPE) has been described after acute airway obstruction. In the following case, we observed a rare occurrence of pulmonary edema caused by chronic tonsillar hypertrophy in a woman following removal of laryngeal mask airway (LMA). A 38-year-old woman with breast cancer underwent mastectomy under general anesthesia using the LMA. ⋯ She was then intubated to secure airway and provide adequate ventilation with PEEP. Fortunately, the symptoms progressively remitted satisfactorily, and she was subsequently extubated 18 hours later with no complications. NPPE is an infrequent medical emergency and its early diagnosis and recognition are likely to lead to successful management of this potentially serious complication.