Masui. The Japanese journal of anesthesiology
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A 9-year-old boy was scheduled for excision of tracheal granuloma which had developed at the tip of a tracheostomy tube. Instead of a tracheostomy tube, a 4 mm ID tracheal tube was inserted via the tracheostomy beyond the tracheal constriction because of rapid development of respiratory failure. General anesthesia was induced and maintained with sevoflurane and oxygen via the tube, and a size 2.5 laryngeal mask airway (LMA) was inserted without muscle relaxant. ⋯ After sealing the tracheostomy, he could breath spontaneously through the LMA. During the excision of tracheal granuloma by holmium:YAG laser, fiberoptic observation was continued via the LMA, and the procedure was performed without any complication. We conclude that the tracheal stenosis can be managed using the LMA, continuous fiberoptic monitoring and additional option of keeping spontaneous ventilation.
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Terumo's Surshield Surflow II i.v. catheter automatically engages a stainless steel clip to shield its needle tip when the needle goes out from the catheter hub. However, in our experience the safety clip of Surshield Surflow II remains in the catheter hub in a high proportion of cases when the catheter hub is held with a pair of forceps. ⋯ Another factor is the loose attachment of the safety clip to the needle tip. To prevent needle stick injury, further improvement of safety i.v. catheters is necessary to lead their increased use.
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We recently had opportunities to use an improved bronchial blocker (Phycon TCB bronchial blocker) in surgical patients who needed separation of the lungs and/or one-lung ventilation. This blocker provides a high torque control and can be easily manipulated into the desired site of the lungs. Our clinical experience shows that this blocker is useful particularly when the quick and sure separation of the lungs is crucial or when the insertion of a double-lumen tube is very difficult.