Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists
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Acta Anaesthesiol Taiwan · Mar 2008
Randomized Controlled Trial Comparative StudyHemodynamic responses to tracheal intubation with the Glidescope videolaryngoscope: a comparison of oral and nasal routes.
Although there have been numerous favorable reports on the uses of the GlideScope videolaryngoscope (GSVL) in oral and nasal intubations, no study has compared the hemodynamic responses to oral and nasal intubations with the GSVL in a single clinical trial. The purpose of this randomized clinical study was to determine whether there was a clinically relevant difference between the hemodynamic responses to oral and nasal intubations with the GSVL. ⋯ In anesthetized adult patients, oral and nasal intubations with the GSVL can result in a similar pressor response. However, the tachycardic response to nasal intubation using a GSVL is smaller and of shorter duration than that to oral intubation using a GSVL.
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Acta Anaesthesiol Taiwan · Mar 2008
Case ReportsProtection against large-volume regurgitated fluid aspiration by the ProSeal laryngeal mask airway.
The ProSeal laryngeal mask airway (PLMA) is designed to protect the airway from regurgitated fluid. However, successful channeling of large volumes of regurgitated fluid by PLMA is rarely reported. This case report states that a large volume of regurgitated fluid was successfully channeled by a PLMA. ⋯ The patient underwent fistula repair a week later and was discharged without further difficulty. This is a unique clinical case report to show PLMA can be effective in preventing aspiration when massive passive regurgitation occurs. Strategies in the management of massive regurgitation during PLMA use are discussed.
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Acta Anaesthesiol Taiwan · Mar 2008
Case ReportsThoracic epidural anesthesia for a polymyositis patient undergoing awake mini-thoracotomy and unroofing of a huge pulmonary bulla.
General anesthesia with one-lung ventilation is a conventional anesthetic strategy for most chest surgery, including resection of pulmonary bullae. However, this anesthetic management may cause alveolar barotrauma, hemodynamic instability, pulmonary atelectasis and long-term ventilator dependency. ⋯ There were no perioperative complications, and the patient was satisfied with the anesthetic care. Pulmonary function tests and daily physical performance also improved postoperatively.
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Acta Anaesthesiol Taiwan · Mar 2008
Case ReportsPenetrating injury of the palatoglossal arch associated with use of the GlideScope videolaryngoscope in a flame burn patient.
The GlideScope is used to facilitate exposure of the larynx in both routine and difficult airways. A 38-year-old woman with a flame burn (second/third-degree, 40% total body surface area) and inhalation injury accompanied by acute respiratory failure under mechanical ventilation support presented for wound debridement and split thickness skin grafting. After the surgery, the endotracheal tube was reinserted successfully with a GlideScope because we anticipated a problematic airway. ⋯ This is a report on a rare complication caused by tracheal intubation associated with the use of the GlideScope. We recommend manipulation of the GlideScope should be performed with care under vigilant surveillance to minimize injury to the oropharyngeal tissues when an endotracheal tube is advanced from the mouth to the pharynx. Potential complications should be always kept in mind when the GlideScope is used for intubation.
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Acta Anaesthesiol Taiwan · Mar 2008
Case ReportsIntrapleural misplacement of a thoracic epidural catheter in an anesthetized patient.
Thoracic epidural analgesia provides adequate postoperative pain relief and favorable outcomes in major operations. However, a small number of devastating complications have been reported. Here we present a case of asymptomatic but potentially life-threatening intrapleural insertion of a thoracic epidural catheter intended for postoperative analgesia. ⋯ After right thoracotomy, the epidural catheter was found in the right pleural cavity and was instantly removed. The patient underwent the operation smoothly and was discharged 10 days later without any sequelae. We recommend practitioners estimate the depth from the skin to the epidural space by computed tomography scan before operation and perform the placement of thoracic epidural catheter while the patient is awake to avoid accidental intrapleural misplacement.