Masui. The Japanese journal of anesthesiology
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Esophagetomy is considered as one of the most invasive surgical procedures. Despite marked advances in surgical techniques, anesthetic management and intensive care, the morbidity and mortality remain still high compared with the other types of surgery. Excessive inflammatory response after surgery induces over-production of inflammatory cytokines, leading to the development of vital organ failures. ⋯ Perioperative respiratory management including early extubation, intensive physical therapy, early mobilization and rehabilitation with enteral nutrition are all important to prevent postoperative complications and to shorten the length of hospital stay. However, some patients need longer-term mechanical ventilation due to preoperative respiratory dysfunction and reduced cough reflex by surgical manipulations. A multimodal treatment is warranted to improve the outcomes after esophagectomy.
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We report our experience of successful nasotracheal intubation with a spiral tube, by using the Pentax-AWS Airwayscope (AWS) with a gum-elastic bougie (GEB) in a patient with invasive recurrent tongue cancer. The patient was a 55-year-old man who had undergone partial resection of the tongue and cervical lymphadenectomy, and was scheduled for extended resection of the tongue and larynx under general anesthesia. Sufficient mask ventilation with the head-tilt and chin-lift maneuver was achieved. ⋯ This allowed us to place the spiral tube uneventfully through the GEB. No evidence of bleeding or damage of the tumor was found. Nasotracheal intubation with the GEB under the guidance of the AWS monitor may be useful in cases such as those involving tongue cancer in which oral space is either narrowed or restricted.
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We describe a case in which fibrinogen concentrate was useful to improve anticoagulation after aortic graft replacement. A 44-year-old man with left ventricular assist system (LVAS) underwent thoracic abdominal aortic aneurysm (TAAA) graft replacement. LVAS requires anticoagulant therapy for thromboprophylaxis. ⋯ Three hours after administration of fibrinogen concentrate, TAAA graft replacement operation was finished. Ten days after the surgery, he was discharged from the ICU. Fibrinogen concentrate might be useful in difficult hemostasis reducing consumption of blood preparations.
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Successful tracheal intubation with a double-lumen tube was achieved using Pentax-AWS Airwayscope (AWS) with an infant-size Intlock in a patient with restricted mouth opening and head tilting. A 78-year-old woman with rheumatoid arthritis was scheduled for extended thymectomy under general anesthesia, with anticipated difficult airway. ⋯ The AWS with an infant-size Intlock facilitated visualization of the glottis, leading to a successful placement of a 32-Fr double-lumen tube under the guidance of the AWS image. Double-lumen tube insertion assisted by the AWS with an infant-size Intlock may be useful for difficult airway management in patients with restricted mouth opening and head tilting.
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We report our experience with the Pentax-AWS Airwayscope with an infant-size Intlock (AWS-I) in a patient with increased intracranial pressure due to acute hydrocephalus. A 12-month-old female infant with increased intracranial pressure due to acute hydrocephalus was scheduled to undergo emergent ventriculoperitoneal shunting under general anesthesia. She had a clonic convulsion and was sedated with midazolam. ⋯ Tracheal intubation while preventing an intracranial pressure increase was needed. After induction of general anesthesia with thiamylal and fentanyl the AWS-I was inserted to obtain a laryngoscopic view without excessive force. Under AWS observation, tracheal intubation was uneventful, and no vital sign change was observed.