Masui. The Japanese journal of anesthesiology
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Anesthesia for patients who undergo surgery for femoral neck fractures can be associated with severe cardiopulmonary complications. ⋯ The surgical techniques selected for hip hemiarthroplasty, which is associate with an increase in intramedullary pressure, may be a significant risk factor for cardiorespiratory deterioration from anesthesia in patients undergoing surgery for femoral neck fracture.
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We describe the clinical use of a new video-laryngoscope (GlideScope, GS) in patients with a difficult airway and morbid obesity. In 4 patients with a difficult airway, showing a Cormack-Lehane grade III view with Macintosh direct laryngoscope, the glottic opening (Cormack-Lehane grade I or II) was visualized with GS. ⋯ GS also provided a good view of glottic opening in a patient with morbid obesity. GS will have a profound impact on the management of the difficult airway.
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Three pregnant women with diagnosis of HELLP syndrome (hemolysis, elevated liver enzymes, and low platelets), received emergency cesarean section in our hospital. Considering low platelet counts, in all three patients, operations were performed under general anesthesia using sevoflurane without epidural or spinal anesthesia. Special attention was paid to management of blood pressure, especially intra-operative hypertension. ⋯ Complications of this syndrome were severe including acute renal failure, DIC, pulmonary edema, cerebral hemorrhage and liver rupture. It is reported that maternal mortality is 2-24%. In the management of pregnant women complicated with HELLP syndrome, early diagnosis and adequate therapy, including preventive therapy for complications, are necessary.
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We experienced a case of the abortive malignant hyperthermia (MH) that had developed during operation. The patient was a 14-year-old girl, and plastic surgery was scheduled under general anesthesia. Serum creatine kinase (CK) levels were high with 505 IU x l(-1) at the preoperative examination. ⋯ As sevoflurane, promotes the CICR (calcium-induced calcium release) mechanism, the trigger of this case is probably sevoflurane. As for the symptom that makes us doubt MH first, there is a maked rapid rises of Et(CO2). Therefore, it is important monitor and recognize the first symptom of MH.
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An AirWay Scope (AWS, PENTAX Corporation, Tokyo, Japan) is a video-laryngoscope with a built-in LCD monitor used for tracheal intubation, while INTLOCK (PENTAX Corporation) is a specialized laryngoscope blade that encases the tip of AWS. The characteristic shape of INTLOCK fits the oropharyngeal anatomy and enables even less experienced operators to obtain an optimal view during tracheal intubation procedures, although it is limited to tracheal tubes of less than 11.5 mm outer diameter. Therefore, AWS is not suitable for double-lumen endobronchial tube (DLT) insertion. To resolve this issue, we developed modified INTLOCK for DLT insertion in cooperation with PENTAX, in which a portion of the tube guide was removed. ⋯ We were able to insert DLT in all subjects using modified INTLOCK without serious complications. The results indicate the usability of the device.