Masui. The Japanese journal of anesthesiology
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A 67-year-old woman with rheumatoid arthritis was scheduled for lumbar anterior fusion (L5-S1). The patient had undergone several major operations on the cervical to the lumbar spine. Cervical spine movement was severely restricted, the mouth opening was limited (inter-incisor distance 3 cm), and the jaw was small (thyro-mental distance 2 cm). ⋯ At the second attempt at fiberoptic intubation a rapidly swollen larynx was observed and awake intubation was abandoned. Fiberoptic intubation could be perfomed after induction of general anesthesia. This case indicates that, although awake fiberoptic intubation is regarded as the safest and the most reliable method, this may also be associated with severe airway obstruction.
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Comparative Study
[Difference in nitrous oxide-mediated increases in intracuff pressure between two tracheal tubes in a simulated pediatric lung model].
The purpose of this study was to compare the nitrous oxide-mediated increases in cuff pressure between a tracheal tube with a tapered cuff (Taper) or conventional high volume low pressure cuff (HVLP) utilizing a simulated pediatric lung model. ⋯ These findings suggest that the Taper may be more effective than the HVLP in preventing hyperinflation of the tracheal tube cuff in response to nitrous oxide exposure in children.
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Comparative Study
[Comparison of TaperGuard tube and the Portex Softseal for prevention of vomitus leakage in an in vitro simulation airway model].
Microaspiration of vomitus can cause a serious condition known as Mendelson's syndrome. The present study used simulated stomach contents and an airway model to compare a tracheal tube with a tapered cuff (Taper) to the conventional high volume low pressure cuff (HVLP) in their abilities to prevent microaspiration. ⋯ We conclude that the Taper may be more effective than the conventional HVLP in preventing vomitus microaspiration in an airway model simulation.
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A 19-year-old male was admitted with diabetic ketoacidosis. A central venous catheter for fluid loading and insulin administration was inserted from the right femoral vein. The catheter was placed for 4days and was removal. ⋯ The surgeon also implanted an inferior vena caval filter. The patient was weaned from ventilator assist next day and was discharged from the hospital 13 days later. This case suggests that deep vein thrombosis should be checked in diabetic ketoacidosis even after removal of a central venous catheter implanted at the femoral vein.
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A 71-year-old male was scheduled for a laparoscopic cholecystectomy. The plan was to intubate him using direct laryngoscopy. After induction of anesthesia and analgesia direct laryngoscopy was performed but it was difficult to get a good view of epiglottis, and at 2nd attempt there was laryngeal edema, which made the procedure more difficult. ⋯ After the operation, the patient was extubated from the trachea with the Aura-i still in place. When sufficient respiration returned, the Aura-i was removed. There was no bleeding in the mouth after removal of the Aura-i.