Masui. The Japanese journal of anesthesiology
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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.
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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 evaluated the preoperative and intraoperative general condition of 33 pediatric kidney recipients. Eighteen patients were anaesthetized with lumbar epidural anaesthesia. Ten patients were with nitrous oxide-oxygen-halothane, 5 cases were with NLA. ⋯ During operation we could not maintain the cardiovascular stability following intratracheal intubation and manipulation of vena cava or abdominal aorta under NLA or nitrous oxide-oxygen-halothane anesthesia. Epidural analgesia inhibited the cardiovascular fluctuation following these surgical stresses. We concluded that epidural analgesia is the best anaesthesia for pediatric renal transplantation and phentolamine or PGE1 are useful to maintain cardiovascular stability and transplanted kidney function.
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Comparative Study
[Haemodynamic effects of vasodilators in dogs--a comparison of prostaglandin E1, nicardipine and nitroglycerin].
Effects of vasodilation by prostaglandin E1 (PGE1), nicardipine (NIC) and nitroglycerin (TNG) were investigated separately in adult mongrel dogs. Mean arterial pressure was lowered and maintained at 90% and 70% of the control value. Cardiac output (CO), pulmonary arterial pressure (PAP), pulmonary capillary wedge pressure (PCWP) and right atrial pressure (RAP) were measured by a thermodilution pulmonary artery catheter and blood flow of hepatic artery (HABF), portal vein (PVBF) and mesenteric artery was measured by electromagnetic flowmetry. 1) PGE1: Heart rate (HR) and CO were unchanged and left ventricular stroke work (LVSW) decreased. ⋯ Though LVSW was unchanged, right ventricular stroke work (RVSW) increased with elevation of PAP. In the hepatic circulation, HABF and PVBF decreased slightly. 3) TNG: LVSW and RVSW decreased significantly. HABF increased slightly and PVBF increased significantly.
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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.