Masui. The Japanese journal of anesthesiology
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A 75-year-old woman suffering from respiratory difficulty was diagnosed with severe tracheal stenosis due o malignant thyroid cancer. She was scheduled for an mergent tracheotomy, but preoperative computed omography revealed severe tracheal stenosis below he glottis due to thyroid cancer invasion. ⋯ Successful tracheal intubation which avoided damage to the tumor was achieved while maintaining spontaneous ventilation. The air-Q intubating laryngeal airway was useful in this setting of severe tracheal stenosis due to thyroid cancer just under the glottis.
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Here, we report successful anesthetic management of posterior cervical spinal fusion utilizing block of the frontal nerve, the greater occipital nerve, and the superficial cervical plexus in a patient with athetoid cerebral palsy. A 69-year-old woman (height 157 cm; weight 33 kg) with athetoid cerebral palsy was scheduled to undergo posterior cervical spinal fusion for cervical spondylotic myelopathy. After induction of general anesthesia, we performed tracheal intubation using the Pentax-AWS Airwayscope with a thin Intlock. ⋯ Continuous administration of dexmedetomidine was started during operation. Following surgery, smooth spontaneous ventilation was observed following uneventful extubation. No significant pain and no athetoid movement were observed under continuous administration of dexmedetomidine.
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A 64-year-old man was scheduled for radical sinus operation. Preoperatively, we did not expect difficult airway. ⋯ We removed i-gel and fiberscope, leaving the AIC in place, and could easily advance a reinforced tube over the AIC into the trachea. Fiberoptic tracheal intubation via the i-gel and AIC is useful in a patient with difficult intubation.
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Case Reports
[Desflurane Anesthesia in a Morbidly Obese Patient with Severe Obstructive Sleep Apnea].
A 33-year-old morbidly obese patient (body mass index = 59.5 kg x m(-2)) with severe obstructive sleep apnea was scheduled to undergo osteosynthesis of right radial, ulnar and femoral fractures under general anesthesia. Awake intubation under conscious sedation using fantanyl and midazolam was performed by the Pentax-AWS Airwayscope. ⋯ Respiratory depression was minimal during postoperative period. In this case desflurane was safely used in a morbidly obese patient with severe obstructive sleep apnea.
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Comparative Study
[Comparison of Seven Intubation Devices in Difficult Airway Model].
The efficacy in tracheal intubation may differ between different video-optical devices, in particular in patients with difficult airways. The purpose of this study was to evaluate the efficacy of video-laryngoscopes and fiberoptic bronchoscope (FOB) in tracheal intubation on a mannequin with several difficult airways, including limited mouth opening, cervical spine rigidity and tongue edema. ⋯ Videolaryngoscopes can generally be useful in patients with all difficult airways, but may be difficult in some circumstances (such as tongue edema). The FOB provided good laryngeal view in all cases, but the success rate of tracheal intubation was low and the time to intubate trachea was long.