Masui. The Japanese journal of anesthesiology
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In tracheal intubation assisted by tube-guiding devices passing through the tube, such as fiberoptic scopes, bougies, tracheal tube exchange catheters, and light wands, passage of the tube-guiding device, by itself, is often easy. But advancing a tracheal tube with a conventional distal tip over these tube-guiding devices is frequently difficult or impossible, because its rigid, side-beveled tip frequently catches on anatomical features of the airway. ⋯ The gapless, midline travel of the Parker tube leads to a greater incidence of first-attempt intubation success with tube-guiding devices, because there is less risk of tube tip hang-ups on the arytenoids and the vocal cords. Clinically, use of the Parker tube is helpful for oral and nasal intubations, especially in patients with difficult airways.
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Spinal anesthesia is a safe and effective anesthetic technique for cesarean section, considering its simplicity, rapidity, accompanied maternal awareness and distribution of anesthetic agents. The problems of spinal anesthesia, hypotension, postdural puncture headache, failed spinal anesthesia, and its duration, have been investigated. Intravenous fluid therapy may reduce the incidence and severity of the hypotension. ⋯ Spinal opioid has improved the quality of spinal anesthesia. The recommended dose of spinal opioid in the recent obstetric anesthesia textbooks has been reviewed. The recent issue about safety and effectiveness in obstetric anesthesia has been briefly discussed.
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The incidence of intracranial hemorrhage is approximately 1-5 in 10,000 pregnancies. In Japan, it is reported that 184 such cases occurred and 10 of them died in 2006. Neurosurgery during pregnancy is required infrequently however a multidisciplinary approach is mandated and anesthesiologists need to modify neuroanesthetic and obstetric practices to accommodate the safety requirements of the mother and fetus. Following the physiologic changes of pregnancy and fetal considerations in nonobstetric surgery during pregnancy, we present the maternal and fetal considerations in anesthesia for intracranial hemorrhage.
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Although, general anesthesia for cesarean section still seems to be the method of choice in extremely urgent settings, past anesthetic evidence has shown that general anesthesia is with increased risk of anesthesia-related maternal mortality. The major disadvantage with general anesthesia is the risk of aspiration of gastric contents and a "cannot ventilate, cannot intubate" situation. ⋯ This review examines the recent knowledge of these topics. We also describe the benefits and risks of new drugs, such as propofol, remifentanil and rocuronium in general anesthesia for cesarean section.
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Maternal mortality rate in Japan decreased dramatically in the last 50 years. It reached 3.2, one of the lowest in the world. ⋯ Uterine displacement, deeper chest compressions, and early tracheal intubation are essential. Emergency cesarean delivery should be considered as soon as a pregnant woman develops cardiac arrest.