Acta anaesthesiologica Taiwanica : official journal of the Taiwan Society of Anesthesiologists
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Acta Anaesthesiol Taiwan · Jun 2008
Case ReportsTemporomandibular joint dislocation after laryngeal mask airway insertion.
Temporomandibular joint (TMJ) dislocation after general anesthesia is not rare. Most victims usually have a past history of TMJ dysfunction or subluxation. It is possible that incomplete TMJ integrity, inadequate articular eminence shape and anesthetic agents that precipitate masticatory muscle hypotonicity are the main factors leading to dislocation. ⋯ TMJ dislocation has been reported after the placement of a laryngeal mask airway for general anesthesia. After reviewing two such cases between August 2004 and July 2007, we found that some iatrogenic factors might intensify the risk of TMJ dislocation. The clinical implications of these findings are discussed herein.
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Acta Anaesthesiol Taiwan · Jun 2008
Review Case ReportsParaplegia following spinal anesthesia in a patient with an undiagnosed metastatic spinal tumor.
Although extremely rare, paraplegia can be a complication following spinal anesthesia if the patient has a previously unrecognized spinal tumor. We describe a 75-year-old male patient who underwent retrograde ureteroscopic examination under spinal anesthesia. He developed complete paraplegia 24 hours later. ⋯ The aim of this case report is to highlight the importance of neurological examination of patients undergoing neuraxial block both in the pre-anesthetic interview and postoperative examination in the recovery period. Careful observation of the postoperative course is essential to exclude any possible neurological complications. If motor and sensory functions do not satisfactorily recover, an MRI examination should be undertaken without delay to determine whether the underlying pathology is treatable or reversible.
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Acta Anaesthesiol Taiwan · Jun 2008
Comparative StudyComparison of the upper lip bite test with measurement of thyromental distance for prediction of difficult intubations.
The upper lip bite test (ULBT) introduced in 2003 is a simple method for predicting difficult intubations. According to this test, the higher a patient can bite the upper lip with the lower incisors, the lower the risk of difficult intubation. Given the necessity for evaluation and re-evaluation of a newer predictive method, this study was conducted to compare the ULBT with another method for difficult airway prediction, the measurement of thyromental distance (TMD). ⋯ The findings suggest that the sensitivity of the ULBT and TMD for predicting difficult intubations may not be significantly different, but the specificity of the ULBT is significantly higher. The positive predictive value of the ULBT was significantly higher than that of TMD, signifying that a positive ULBT is more predictive of a difficult airway than is a positive TMD.
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Acta Anaesthesiol Taiwan · Jun 2008
Case ReportsEmergency tracheal intubation in an ankylosing spondylitis patient in the lateral position using the GlideScope.
Anesthesia for ankylosing spondylitis (AS) patients with difficult airway is of great stress to anesthesiologists. If tracheal intubation is not mandatory for general anesthesia, laryngeal mask airway (LMA) may suffice for adequate ventilation. ⋯ General anesthesia with sevoflurane conveyed by an LMA through spontaneous ventilation in the lateral decubitus position was planned, and the induction was smoothly done. Unfortunately, laryngospasm and oxygen desaturation occurred during the operation; the patient was successfully rescued by nasal intubation with a GlideScope in the lateral decubitus position without interrupting the operation.
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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.