Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Clinical Trial
[Evaluation of a pressure and volume-relief instrument (modified Brandt's rediffusion system) to prevent increase in endotracheal tube cuff pressure].
Nitrous oxide diffuses into the endotracheal tube cuff and then overexpand the cuff. This causes upper airway obstruction and trauma in intubated patient during general anesthesia. We evaluated the efficacy and a safety of a pressure and volume-relief instrument (modified Brandt's rediffusion system), which can easily be made by ourselves, to prevent increases in endotracheal tube cuff pressure. ⋯ Pressure of endotracheal tube cuffs was monitored and recorded until the extubation. Time interval until the pressure of tube cuffs increased more than 23 mmHg, which inhibit the local circulation on the tracheal cartilage, in rediffusion group (274.7 +/- 95.9 min) was significantly longer than the duration in control group (64.7 +/- 23.5 min). We conclude that the rediffusion instrument is effective and safe to prevent the rise in the pressure of an endotracheal tube cuff.
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Randomized Controlled Trial Comparative Study Clinical Trial
[A better method to attach an endotracheal tube to the stylet of the Bullard laryngoscope].
The Bullard laryngoscope with its introducing stylet is useful in a variety of patients with airway problems, but it poses difficulties in some cases where an endotracheal tube (ETT) catches on the ary-epiglottic fold and cannot be advanced into the trachea. This difficult may be avoided by slightly angulating the tip of the ETT so that it is directed in a better alignment toward the rima glottis. The efficacy of the two methods of angulation was studied. ⋯ Intubation on the first attempt was successful in 56% of group 1, 83% in group 2 and 100% in group 3. The patients in groups 1 & 2 in whom first attempt failed were all successfully intubated on the second trial with the method used in group 3. This method (180 degrees rotation of the ETT on the stylet), is applicable to any ETT with or without the Murphy eye.
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Case Reports
[Right ventricular perforation and cardiac tamponade caused by a central venous catheter].
A 5 year old girl with ASD was scheduled for open heart surgery. A central venous catheter was placed via the right infraclavicular vein after induction of anesthesia. Thirty minutes after insertion of the catheter, a decrease in arterial pressure and pulse pressure, an increase in heart rate and central venous pressure were observed. ⋯ Gushing blood out of a hole in the right ventricular free wall was confirmed by pericardiotomy. The hemodynamics were stabilized by blood transfusion and surgical closure of the hole on the ventricle. This perforation was thought to be caused by careless insertion of a relatively stiff central venous catheter.
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We examined the relationship between the degree of difficulty in visualization of the larynx and the distance from the lower border of the mandible to the thyroid notch (M-T distance). Patients were examined and the M-T distance was measured with their neck fully extended during preoperative period. Difficulty of laryngoscopy was graded as reported previously. ⋯ These were significantly different with each other (P < 0.05). If the M-T distance is 4.5 cm or less, the difficulty in visualization of laryngoscope increases. Therefore, in the case in which the M-T distance is 4.5 cm or less, we recommend further examination and preparation for difficult laryngoscopy.
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We experienced a case of difficult endotracheal intubation. The patient was a 43 year-old female with congenital oropharyngeal wall stenosis. She was suffering from fibromyoma of uterus and an operation was scheduled under general anesthesia. ⋯ Ordinary endotracheal intubation was impossible because of the stenosis. In this case, fortunately we succeeded fiberoptic endotracheal intubation under spontaneous respiration. We conclude that the examination of the pharynx is very important during the perioperative period.