Journal of anesthesia
-
Journal of anesthesia · Apr 2016
Challenge to pediatric anatomical variation : Can we draw the ideal line on the pediatric I-gel?
I-gel is a noncuff type of laryngeal airway mask. No horizontal line has yet been determined as an ideal position for pediatric sizes because of the variability in length of the oropharyngeal-laryngeal arch in children. We investigated whether there is a correlation between insertion length and patient body weight or height for the pediatric I-gel sizes from 1.5 to 2.5. ⋯ Results suggested that it is possible to draw an ideal line on the I-gel with sizes 1.5 and 2 only.
-
Journal of anesthesia · Apr 2016
Are prehospital airway management resources compatible with difficult airway algorithms? A nationwide cross-sectional study of helicopter emergency medical services in Japan.
Immediate access to the equipment required for difficult airway management (DAM) is vital. However, in Japan, data are scarce regarding the availability of DAM resources in prehospital settings. The purpose of this study was to determine whether Japanese helicopter emergency medical services (HEMS) are adequately equipped to comply with the DAM algorithms of Japanese and American professional anesthesiology societies. ⋯ In Japan, compliance with standard airway management algorithms in prehospital settings remains difficult because of the limited availability of alternative ventilation equipment and back-up personnel. Prehospital health care providers need to consider the risks and benefits of performing endotracheal intubation in environments not conducive to the success of this procedure.
-
Journal of anesthesia · Apr 2016
ReviewEmergence agitation in children: risk factors, prevention, and treatment.
Emergence agitation (EA) in children is a major postoperative issue that increases the risk of patient self-harm, places a burden on nursing staff, and reduces parent satisfaction with treatment. Risk factors for EA include age, preoperative anxiety, patient personality, pain, anesthesia method, and surgical procedure. ⋯ Maintenance of anesthesia using propofol has also been shown to prevent EA. In children, anesthesia methods that are unlikely to cause EA should be selected, with the prompt adminstration of appropriate treatment in cases of EA.
-
Journal of anesthesia · Apr 2016
Case ReportsCombined nephrectomy and aortic valve replacement: perioperative decision-making.
Open heart surgery and urologic surgery may be required for patients with coincident diseases. We report a patient who suffered from aortic valve stenosis which was asymptomatic barring atrial fibrillation. ⋯ Traditionally, severe cardiac disease is addressed first before conducting elective noncardiac surgery; however, this option was not available since the patient already had a perinephric hematoma which could bleed more when subjected to systemic heparinization for cardiopulmonary bypass. Here, we describe the process of perioperative decision-making involving multiple specialities and re-examine several guidelines.
-
Journal of anesthesia · Apr 2016
Case ReportsAnesthetic management of nonintubated video-assisted thoracoscopic surgery using epidural anesthesia and dexmedetomidine in three patients with severe respiratory dysfunction.
Nonintubated video-assisted thoracoscopic surgery (VATS) has been reported to be safe and feasible for patients with various thoracic diseases, including those who have respiratory dysfunction. In nonintubated VATS, it is important to maintain spontaneous respiration and to obtain a satisfactory operating field through adequate collapse of the lung by surgical pneumothorax. Therefore, we need to minimize the patient's physical and psychological discomfort by using regional anesthesia and sedation. ⋯ Here, we report three patients with severe respiratory dysfunction who underwent nonintubated VATS for pneumothorax using epidural anesthesia and DEX. In all three patients, DEX infusion was started after placement of an epidural catheter and was titrated to achieve mild sedation, while maintaining communicability and cooperation. This seems to be a promising strategy for nonintubated VATS in patients with respiratory dysfunction, as well as patients with normal respiratory function.