Masui. The Japanese journal of anesthesiology
-
In 1984, Cormack and Lehane defined laryngoscopic view in four grades. As the view worsens, the difficulty of intubation may increase but it is not clear. In this study, we examined the endotracheal intubation techniques to the grade III or IV airways. ⋯ In conclusion, the grade III or IV airways were not always difficult to intubate. But when the conventional technique failed, the gum-elastic bougie or laryngeal mask airway was a fairly useful aid to endotracheal intubation. Moreover our handmade flexible guide tube made the intubation through the laryngeal mask airway safe and reliable.
-
We described a case of anaphylaxis diagnosed by the evaluation of plasma mast cell tryptase and a case of anaphylactoid reaction. In a patient undergoing pulmonary lobectomy, anaphylaxis, showing the elevation of plasma tryptase, was provoked by physiological glue for hemostasis during the operation. During the operation, cardiovascular collapse occurred suddenly, at which time the cause was not diagnosed. ⋯ Increase in plasma histamine concentration to 4.94 ng.ml-1 that could induce systemic reaction was noticed; however, concentrations of plasma tryptase 25 min, 3h and 7h after the episode were not elevated. This finding indicated that the adverse reaction was not based on degranulation of mast cell, and was anaphylactoid reaction provoked by nonspecific histamine-release. In conclusion, measurement of plasma tryptase is a useful method for differential diagnosis of anaphylaxis and anaphylactoid reaction.
-
We evaluated the effects of anesthetic drugs and temperature on brain stem and mid-latency evoked potentials (BAEP and MLAEP) in 20-patients who were scheduled for elective cardiac operation using cardiopulmonary bypass with moderate hypothermia. At esophageal temperature of 36 degrees C, the latency of MLAEP was slightly prolonged by the increase of fentanyl dose, which suggested that the latency prolongation of MLAEP could not block the oscillation of auditory stimulation. ⋯ The latency of BAEP was markedly prolonged at 27 degrees C and returned to the normal latency at 36 degrees C. The latency of MLAEP retained by high dose fentanyl suggests that patients may be aware during cardiopulmonary bypass at normothermia, and BAEP may be one of the useful brain function monitors during cardiopulmonary bypass.
-
PSV has been increasingly used as a partial ventilatory support for various types of respiratory failure. We experienced premature breath termination and double triggering in a patient with ARDS during PSV, and investigated the cause of this phenomenon using respiratory muscle pressure (Pmus). ⋯ The limitation of synchronization was attributable to fixed flow termination criteria in the present PSV algorithm. When dissynchronization is not manageable, other ventilatory modes (eg, APRV, PCV) allowing spontaneous ventilation should be considered as an alternative.
-
Comparative Study Clinical Trial
[The utility of thermistor attached tracheal tube for pediatric patients in cardiac surgery].
During cardiac surgery, esophageal, rectal, or bladder temperature is usually monitored as an index of core temperature; however, these methods are invasive, and often inconsistently reflect the central body temperature, especially in pediatric patients. The purpose of this study was to evaluate the utility of tracheal temperature monitoring during cardiac surgery in pediatric patients. Fifteen children (ages; 8 m.-7 yr.) undergoing cardiac surgery with cardio-pulmonary bypass (CPB) were studied. ⋯ There were also good correlations of the esophageal as well as bladder temperatures with blood temperature. There were no patients who suffered tracheal inflammation or laryngeal edema from the thermistor. Monitoring tracheal temperature is not only valuable for monitoring the core temperature, but also is convenient for pediatric patients in cardiac surgery.