Masui. The Japanese journal of anesthesiology
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Although tracheal laceration during surgical procedure is a rare complication, it can be life-threating. Its immediate recognition and treatment are important. A 72-year-old man with aortic valve regurgitation was scheduled for aortic valve replacement. ⋯ Air leaks were no longer present. After surgical repair, the aortic valve replacement was performed. The postoperative courses of both tracheal laceration repair and aortic valve replacement were uneventful.
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A 6-month-old girl with Treacher Collins syndrome was scheduled for tracheotomy because of severe airway obstruction. During slow induction of anesthesia with inhalation of sevoflurane, assisted mask ventilation was successfully performed using oropharyngeal airway. ⋯ Laryngeal mask airway (LMA) was inserted easily and allowed adequate ventilation, through which fiberoptic intubation was successfully achieved. We cut the LMA short in order to pass the 3 mm tracheal tube until the glottis through it.
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Case Reports
[Case of pharyngeal laceration associated with the use of airwayscope in a patient with difficult airway].
A 54-year-old woman with atlantoaxial subluxation in rheumatoid arthritis was scheduled for total elbow arthroplasty. Since her neck was stabilized with a cervical collar and her interincisor distance was 1.5 finger-breadth, a difficult airway was anticipated. Anesthesia was induced with propofol and fentanyl. ⋯ Following aspiration of blood, the trachea was intubated using a flexible fiberoptic bronchoscope under AWS guidance. After the operation, a view of bronchoscopy by an otolaryngologist revealed three lacerations from the mucosa to muscle layer in the pharynx. The lacerations could have resulted from use of AWS in a patient with a small mouth opening and with vulnerable mucosa due to long-term steroid therapy.
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Ultrasound-guided peripheral nerve blocks in the abdominal wall, such as transversus abdominis plane block (TAP block) and rectus sheath block, are now widely used. We report a case of Leriche's syndrome treated with safe and effective analgesia after laparotomy by abdominal wall block and continuous infusion. A 61-year-old man diagnosed with Leriche's syndrome underwent Y-graft replacement for an abdominal aortic aneurysm. ⋯ When the wound was closed, a catheter was passed through an 18-gauge Tuohy needle placed above the fascia along the supraumbilical site. After the operation, 0.2% ropivacaine was continuously delivered at a rate of 6 ml hr-1 through the catheter. We could provide the patient with effective analgesia after surgery.
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We report a case of ventilation failure due to supraglottic air leakage with the use of uncuffed tracheotomy tube. A 4-year-old girl with 22q11.2 deletion syndrome after tracheotomy due to tracheomalacia developed left caudate bleeding and was admitted urgently. She required mechanical ventilation but suffered from a supraglottic air leakage which prevented adequate ventilation via a tracheostomy site. ⋯ The supraglottic air leakage was not detected under mandatory mechanical ventilation following seal of the connector of the LMA with a piece of tape. The respiratory condition of the patient improved gradually. The use of an LMA may be useful to stop or significantly decrease the air leak.