Masui. The Japanese journal of anesthesiology
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Cardiac arrest during pregnancy is a rare event but it needs rapid and effective cardiopulmonary resuscitation to prevent loss of two lives. In this questionnaire survey, G2010 AHA-BLS Healthcare Provider Course participants answered four questions about CPR caveats which should be considered during pregnancy. The correct answer ratio is generally low among the four questions. Special situation explanation addition such as left uterine displacement in the AHA-BLS healthcare provider course may be needed for the empowerment of knowledge about cardiopulmonary resuscitation during pregnancy.
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It is recommended to avoid overinflation of the bronchial cuff, leading to ischemic pressure damages to the respiratory mucosa and bronchial rupture. We investigated the minimum bronchial cuff pressure of 35 Fr double lumen tubes (DLTs) during one lung ventilation using a capnometer. ⋯ In this study, the bronchial pressure higher than 12 cmH2O was not necessary for one lung ventilation. If high intracuff pressure is necessary to seal the bronchus, there are possibilities of the incompatibility of the size of DLT and the herniation of the bronchial cuff to the proximal side. The method of confirmation of OLV using a capnometer can display the non ventilated condition on the monitor objectively. We can thus decrease troubles during operations.
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A 54-year-old man with lung cancer was scheduled for thoracoscopic upper lobe resection under general anesthesia. About half a year previously, he had undergone surgery for oropharyngeal cancer and tongue cancer. As a result of the surgery, elasticity of the neck skin bending of the neck were restricted (Mallampati classification IV). ⋯ The third person inserted the Glidescope to shift the transplanted tongue to the side. It was then possible for the forth anesthesiologist to manage to see the glottis using a fiberoptic bronchoscope, and a double-lumen tube (DLT) could be inserted to the trachea orally. Inserting a DLT over the fiberoptic bronchoscope is a blind method, but we felt that combined with a variety of tools such as video laryngoscope, the success rate in intubation will increase.
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Here we report a case of severe septic shock immediately following cesarean section. A pregnant woman with dichorionic diamniotic twins was diagnosed with preterm rupture of membranes (PROM). Ritodrine hydrochloride and betamethasone did not sufficiently relieve abdominal extension; emergency cesarean section was scheduled 4 days later, at 31 week 5 day gestation. ⋯ Catecholamine and antibiotics relieved her symptoms. Retrograde infection of Escherichia coli was attributed to fetal distress and septic shock. Early phase septic shock should be considered in pregnant women with PROM.
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Pregnancy-related mortality, estimated to occur in approximately 1: 50,000 deliveries, is rare in developed countries. The 2010 American Heart Association (AHA) Guidelines for Resuscitation emphasize the importance of high-quality chest compression as a key determinant of successful cardiopulmonary resuscitation. ⋯ When CPR is performed on parturients in the LLT position, chest compressions will probably be more effective if performed with the operator standing on the left side of the patient. The videolaryngoscope Pentax-AWS Airwayscope (AWS) was found to be an effective tool for airway management during chest compressions in 27 LLT simulations, suggesting that the AWS may be a useful device for airway management during maternal resuscitation.