Masui. The Japanese journal of anesthesiology
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Case Reports
[Usability of AirWay Scope for awake tracheal intubation in a burn patient with difficult airway].
The AirWay Scope (AWS; PENTAX Corporation, Tokyo, Japan) is a newly developed rigid video laryngoscope with a built-in LCD monitor that provides accurate verification of tube passage through the vocal cords during tracheal intubation procedures. The blade is shaped to fit the oropharyngeal anatomy, which enables operators to achieve an optimal view for tracheal intubation without requiring alignment of the oral, pharyngeal, and laryngeal axes. We used an AWS for awake intubation in a 34-year-old male burn patient with a difficult airway under conscious sedation obtained with infusion of dexmedetomidine (DEX). ⋯ Thereafter, insertion of the AWS gave a Cormack grade 1 glottic view, and endotracheal anesthesia was provided by use of a modified spray tube through the AWS blade without patient anxiety or discomfort. The trachea was intubated using the AWS without respiratory depression or other complications while the patient was sedated (Ramsay sedation scale class 4). We consider the AWS to be useful for awake tracheal intubation in patients with a difficult airway.
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Case Reports
[Case of unexpected epiglottic cyst found during endotracheal intubation by an emergency medical technician trainee].
A 66-year-old man was scheduled for endoscopic right uretherectomy under general anesthesia. On the pre-anesthesia examination, the patient had no respiratory symptoms. An informed consent for endotracheal intubation by a trainee for emergency medical technician was obtained on the examination. ⋯ Although the patient had been informed about the cyst before the surgery, he did not disclose it as he did not have any symptom from the cyst. This case suggest that unpredictable airway problem could occur in any anesthetic practice. The video-laryngoscope was useful in such a case to prevent fatal complication developing on endotracheal intubation by a trainee, and also it is a good tool to show the trainee how severe the cyst related-airway trouble would be.
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We report a case of lethal air embolism just after spray of adhesive-fibrinogen and factor XIII aerosol during laparoscopic surgery. A 76-year-old man underwent laparoscopic partial nephrectomy for the left renal cancer. ⋯ Trans-esophageal echocardiography and computed tomography after cardiopulmonary resuscitation confirmed multiple air embolism. The use of a spray aerosol during laparoscopic surgery may be associated with the risk of lethal air embolism.
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According to the instruction manual, the sniffing position (SP) and the slight lateral approach (SLA) are the recommended insertion methods using Proseal laryngeal mask airway (PLMA). However, the efficacy of these methods has not been assessed. ⋯ It was suggested that Full-SP and SLA were useful to place PLMA in patients with insertion difficulty.
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We have examined the effect of dexmedetomidine, a selective alpha2-adrenoreceptor agonist, for controlling delirium in patients in the intensive care unit. ⋯ Dexmedetomidine is effective for controlling delirium and provides sufficient sedation without respiratory adverse effects in patients in the intensive care unit. It is also effectively and safely used in patients with respiratory failure.