Journal of anesthesia
-
Journal of anesthesia · Oct 2010
Tracheal intubation by paramedics under limited indication criteria may improve the short-term outcome of out-of-hospital cardiac arrests with noncardiac origin.
It is not clear whether advanced airway management (AAM) with an endotracheal tube (ET) by paramedics may improve the outcome of out-of-hospital cardiac arrest (OHCA) compared with the use of a bag-valve-mask device (BVMD) and other AAM devices. ⋯ When subjects with difficult airway are excluded, tracheal intubation according to the limited indication criteria and well-organized protocol in Japan may improve the short-term outcome of OHCA of noncardiac origin. A large prospective study is needed to determine the general effects of tracheal intubation on the long-term outcome of OHCA with disturbed ventilation.
-
Journal of anesthesia · Oct 2010
Case ReportsAwake intubation under sedation using target-controlled infusion of dexmedetomidine: five case reports.
We used target-controlled infusion (TCI) of dexmedetomidine (DEX) for awake intubation under sedation in 5 patients who had a risk of pulmonary aspiration or difficult airway. Dexmedetomidine level was escalated stepwise until the patients developed tolerance to laryngoscopy. The target DEX concentrations at the time of intubation were 2.10-5.95 ng/ml and were higher than those clinically used for sedation in the intensive care unit (ICU). ⋯ Reflex to intubation was preserved in all cases, and coughing was observed in all cases. The patients had no memory of discomfort and/or intubation. Although further investigations are needed, this method may be useful for awake intubation under sedation.
-
Journal of anesthesia · Oct 2010
Case ReportsEffective control of paroxysmal tachycardia with landiolol hydrochloride during cesarean section in a patient with hypertrophic obstructive cardiomyopathy.
Hypertrophic obstructive cardiomyopathy (HOCM) involves marked hypertrophy of cardiac muscle, resulting in myocardial ischemia and arrhythmia because of left ventricular diastolic dysfunction. In perioperative management of HOCM, hemodynamic stabilization is required, by prevention of arrhythmia and tachycardia and maintenance of preload and afterload. Here, we describe anesthesia management during cesarean section in a patient complicated by HOCM. ⋯ Circulatory dynamics stabilized and landiolol was discontinued 3 h after she was admitted to the intensive care unit. Her circulatory dynamics remained stable after discontinuation of landiolol, and she was moved to a general ward on the following day. She was discharged on postoperative day 14, with her child.
-
Journal of anesthesia · Oct 2010
Case ReportsParadoxical carbon dioxide embolism during endoscopic thyroidectomy confirmed by transesophageal echocardiography.
Carbon dioxide (CO₂) embolism is a rare but potentially life-threatening complication of laparoscopic procedures. Although endoscopic thyroidectomy using CO₂ gas insufflation appears to be superior to conventional open thyroidectomy in terms of cosmetic results, it may cause venous or fatal paradoxical CO₂ embolism. ⋯ The patient recovered without complications. In conclusion, although endoscopic thyroidectomy is a promising approach that is gaining popularity and offers excellent cosmetic results compared with conventional open thyroidectomy, this case report emphasizes the importance of anticipating and being vigilant for potential CO₂ embolism.
-
Journal of anesthesia · Oct 2010
Case ReportsAnesthetic case in a child with congenital neuromuscular disease with uniform type 1 fibers (CNMDU1).
Congenital neuromuscular disease with uniform type 1 fibers (CNMDU1) is an extremely rare, non-progressive, congenital neuromuscular disorder. Although the etiology is unknown, ryanodine receptor gene mutation is reportedly involved. No descriptions of anesthetic practice in patients with this disease have been reported around the world. We report a case of safe perioperative management with general anesthesia, using total intravenous anesthesia, propofol, fentanyl and a non-depolarizing muscle relaxant but avoiding the use of any inhaled anesthetics or depolarizing muscle relaxants to prevent malignant hyperthermia and postoperative respiratory failure, during anesthetic management for cranioplasty for premature synostosis of the cranial sutures in a pediatric patient of CNMDU1.