Masui. The Japanese journal of anesthesiology
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Anesthesia for patients who undergo surgery for femoral neck fractures can be associated with severe cardiopulmonary complications. ⋯ The surgical techniques selected for hip hemiarthroplasty, which is associate with an increase in intramedullary pressure, may be a significant risk factor for cardiorespiratory deterioration from anesthesia in patients undergoing surgery for femoral neck fracture.
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A 27-year-old man underwent the right knee joint operation under general anesthesia with CLM. After the operation, he complained of taste disturbance of the left side of the tongue. ⋯ The taste threshold was elevated in the two nerve areas of the left side of the tongue (chorda tympani, N. glossopharyngeus) and the serum levels of zinc and iron were low. We concluded that he had been short of zinc and iron and the insertion of CLM had triggered taste disturbance.
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We describe the clinical use of a new video-laryngoscope (GlideScope, GS) in patients with a difficult airway and morbid obesity. In 4 patients with a difficult airway, showing a Cormack-Lehane grade III view with Macintosh direct laryngoscope, the glottic opening (Cormack-Lehane grade I or II) was visualized with GS. ⋯ GS also provided a good view of glottic opening in a patient with morbid obesity. GS will have a profound impact on the management of the difficult airway.
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An AirWay Scope (AWS, PENTAX Corporation, Tokyo, Japan) is a video-laryngoscope with a built-in LCD monitor used for tracheal intubation, while INTLOCK (PENTAX Corporation) is a specialized laryngoscope blade that encases the tip of AWS. The characteristic shape of INTLOCK fits the oropharyngeal anatomy and enables even less experienced operators to obtain an optimal view during tracheal intubation procedures, although it is limited to tracheal tubes of less than 11.5 mm outer diameter. Therefore, AWS is not suitable for double-lumen endobronchial tube (DLT) insertion. To resolve this issue, we developed modified INTLOCK for DLT insertion in cooperation with PENTAX, in which a portion of the tube guide was removed. ⋯ We were able to insert DLT in all subjects using modified INTLOCK without serious complications. The results indicate the usability of the device.
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Noninvasive positive pressure ventilation (NPPV) has recently been applied to patients with left ventricular dysfunction. We report a female patient who showed low cardiac output syndrome and pulmonary hypertension after cardiac surgery. After tracheal extubation, she developed cardiogenic pulmonary edema associated with an increase in extravascular lung water (EVLW). ⋯ However, once we weaned her from NPPV EVLW increased and pulmonary edema was revealed. On post-operative day 9, we finally weaned her from NPPV when baseline value of EVLW became small, probably due to supportive therapy including afterload reduction. We suggest that, in patients with left ventricular dysfunction, NPPV should be considered and EVLW may be a useful parameter to adjust the support.