Masui. The Japanese journal of anesthesiology
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Case Reports
[Fiberscopic intubation under general anesthesia for children with Goldenhar syndrome].
Goldenhar syndrome is characterised by an eye abnormality such as epibulbar dermoid and lipoma, associated with ear, mandibular, and/or vertebral anomalies. It is well documented that difficult intubation in patient with this syndrome may be expected because of mandibular hypoplasia and limitation of neck movement resulting from vertebral anomalies. We report anesthetic management of two children with Goldenhar syndrome, 9 and 14-year-old. ⋯ By using this adapter, under sevoflurane/nitrous oxide anesthesia with vecuronium, we could successfully intubate with a 6 mm spiral tube through the nostril without any major problems. Anesthesia and surgery went uneventfully, and no postoperative complications were noted. We confirmed that our newly developed mask adapter for fiberoptic bronchoscopy is as useful for children with difficult intubation as for adults.
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To investigate the concentration effects of isoflurane-nitrous oxide anesthesia on cardiovascular responses to skin incision, we studied 24 non-premedicated patients undergoing lower abdominal operation. Anesthesia was induced with inhalation of 70% nitrous oxide and isoflurane, and maintained with 70% nitrous oxide and three different concentrations of isoflurane (1.25, 1.6, 1.95 MAC). ⋯ Cardiovascular responses at skin incision were not completely suppressed at 1.6 MAC isoflurane-N2O anesthesia and no further blocking effects were obtained at 1.95 MAC isoflurane-N2O anesthesia. These results suggest that higher concentration of isoflurane does not guarantee stronger protective effects on stimulation like skin incision.