Masui. The Japanese journal of anesthesiology
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MAC is often required for pediatric examinations outside of operating room. It is difficult to conduct MAC for pediatric population safely. ⋯ This proposal consists of six parts; 1. informed consent 2. pre-sedation patient assessment, 3. back-up team for emergency, 4. pre-sedation NPO, 5. patient monitoring, and 6. post-sedation care. Anesthesiologists are expected to play supervisor roles of sedation operation to make the sedation environment safe, even though they can not conduct sedation by themselves.
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Case Reports
[Use of the i-gel for Tracheostomy in a Patient with Neck Deformity and Tracheal Stenosis].
We report a successful use of the i-gel for tracheostomy in a patient with severe neck deformity and tracheal stenosis. A 20-year-old man, 142 cm, 22 kg, was scheduled for tracheotomy. He had tracheal stenosis with hypoxemia, due to the pressure from the brachiocephalic artery, associated with severe progression of symptomatic scoliosis and thoracic deformity. ⋯ The i-gel was easily inserted, and fiberscope-aided tracheal intubation through the i-gel was attempted, but decided not to intubate the trachea, due to the degree of stenosis. Tracheostomy was performed, while a clear airway was maintained by the i-gel. We consider that the i-gel has a potential role for tracheostomy in a patient with neck deformity and tracheal stenosis.
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Randomized Controlled Trial
[Hypotonic Versus Isotonic Electrolyte Solution for Perioperative Fluid Therapy in Infants].
This study was designed to evaluate the effects of perioperative administration of an isotonic electrolyte solution with 1% glucose (IT) on blood sodium (Na+) and blood glucose (BG) concentrations in pediatric patients < 1-year-old undergoing plastic surgery in comparison with a conventional hypotonic electrolyte solution with 2.6% glucose (HT). ⋯ Isotonic solution with 1% glucose is suggested to be safe in infants during and after surgery.
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Here we report a case of successful awake nasal intubation with the McGrath videolaryngscope (McGrath) in conjunction with a soft-tipped extra firm exchange catheter in a patient with a necrotic mandible developing a hole. An 81-year-old woman underwent partial tongue resection and cervical lymph node dissection. After additional radiation therapy, she developed a necrotic mandible with a hole from the oral cavity to the neck region. ⋯ Upon sedation with dexmedetomidine 1.0 μg xkg-(1 )-xhr-(1 )and applying topical anesthesia with lido-aine, we inserted the McGrath orally and the soft- ipped extra firm tube exchange catheter (TE) nasally. Under the guide of the McGrath's monitor, we inserted the TE, using Magill forceps, into her trachea. A 6.0 mm internal diameter spiral tracheal tube was inserted via the TE uneventfully.
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The purpose of this study was to compare the upper gastrointestinal endoscope (UGE) insertion-mediated cuff pressure increase between a tracheal tube with a tapered cuff (Taper) and or conventional high volume low pressure cuff (HVLP) utilizing a porcine larynx model. ⋯ These findings suggest that the Taper may be more effective than the HVLP in preventing tracheal tube cuff increase by UGE insertion.