Masui. The Japanese journal of anesthesiology
-
Lingual tonsillar hyperplasia is rare, but may cause difficult or impossible tracheal intubation. We administered anesthesia to a female patient with a body mass index (BMI) of 47 kg x m(-2) with unexpected lingual tonsillar hyperplasia. A 32-year-old woman was scheduled for surgery to repair a ventral hernia under general anesthesia. ⋯ We replaced the LMA with an intubating laryngeal mask airway (ILMA) for the purpose of tracheal intubation. Finally, the patient's trachea was intubated by ILMA with fiberoptic bronchoscopy. Several methods for tracheal intubation for the patients with lingual tonsillar hypertrophy have been reported; the insertion of an ILMA might be considered for safe airway management in combination with a fiberscope.
-
Fiberoptic intubation is the most reliable method in patients with difficult airways, but it may be difficult in patients with restricted neck movement. The intubating laryngeal mask airway facilitates fiberoptic intubation, but its insertion may also be difficult in some circumstances. We experienced a case of successful tracheal intubation using the Pentax-AWS (Airway Scope) after failed fiberoptic intubation and failed insertion of the intubating laryngeal mask. ⋯ Insertion of the laryngeal mask also failed, because the pharyngeal swelling prevented its insertion. Insertion of the Pentax-AWS was unaffected by the swelling and tracheal intubation was successful within 10 sec. We believe that the Pentax-AWS can be useful in the patient with restricted neck movement in whom both fiberoptic intubation and insertion of the laryngeal mask have failed.
-
Case Reports
[Hemodynamic changes during pregnancy and cesarean delivery in three cases of triplet pregnancy].
Polypregnancy is one of the major problems to both mothers and fetuses leading to poor prognosis. Even though hemodynamic parameters change greatly during pregnancy and cesarean delivery, it is unclear how blood volume (BV) and cardiac output (CO) increase during triplet pregnancy and how CO goes up and down during cesarean delivery in the cases of triplet pregnancy. ⋯ However, there was no such tendency in CO. When they underwent cesarean delivery under combined spinal-epidural anesthesia (CSEA) or sequential-CSE (S-CSE) receiving a 10 or 12 mg intrathecal isobaric bupivacaine with 20 microg fentanyl, CO decreased in parallel with blood pressure from ten minutes after spinal anesthesia, to the start of operation and just after the birth of third fetus.