Masui. The Japanese journal of anesthesiology
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Pentax AirWay Scope (AWS) is a new videolaryngoscope which allows indirect visualization of the vocal cords and provides a better laryngeal view compared with the conventional Macintosh laryngoscope. We report a female patient who developed distinctive upper airway edema after palatal laceration at the time of insertion of the AWS. She was scheduled for tympanoplasty. ⋯ Then, the tracheal tube was left for three days after the operation, to secure the airway until the reduction of airway edema. On the postoperative day 4, following the fibroscopic confirmation that the airway edema was reduced, the patient was extubated successfully. AWS should be used more carefully, especially at the time of insertion along the palate.
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We experienced anesthesia for a female patient of BMI 39.2 with unanticipated lingual tonsillar hyperplasia. At the induction of anesthesia, both mask ventilation and tracheal intubation were difficult due to the lingual tonsillar hyperplasia. ⋯ Following the extubation, the opening of the respiratory tract was evaluated by TE and the fiberoptic bronchoscopy. In this case we confirmed that the ASA difficult airway algorithm was also useful in the presence of lingual tonsillar hyperplasia.
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Randomized Controlled Trial
[Exposure to nitrous oxide may increase airway inflammation during sevoflurane anesthesia].
The purpose of this study was to examine whether nitrous oxide increases the inflammatory reaction in the airway in patients undergoing minor surgery. ⋯ The pulmonary immunologic function changed progressively during anesthesia, surgery and positive pressure mechanical ventilation. The data from this study suggest that the immune ability of the lung may possibly change due to the administration of nitrous oxide. As a result, our findings suggest that the postoperative inflammatory reaction in the lung may increase when sevoflurane plus nitrous oxide are used during general anesthesia.
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Randomized Controlled Trial
[Balanced anesthesia with continuous ketamine reduces adverse effects of remifentanil].
We evaluated the use of continuous infusion of ketamine to reduce intraoperative remifentanil side effects, such as bradycardia and hypotension, and to improve postoperative analgesia from balanced anesthesia with remifentanil. ⋯ Remifentanil-based anesthesia with continuous ketamine decreases intraoperative side effects and postoperative NSAIDs request. Thus, intraoperative continuous ketamine may be a useful adjuvant to remifentanil.
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Case Reports
[Case of transfusion-related acute lung injury associated with severe intraoperative hypoxemia].
A 39-year-old woman, undergoing debridement and flap reconstruction for a soft tissue infection in an upper limb, developed transfusion-related acute lung injury (TRALI) and hypoxemia after an intraoperative transfusion. Perioperatively, she received 8 units of packed red blood cells (RBCs) and 5 units of fresh frozen plasma. Shortly thereafter, hemoglobin oxygen saturation decreased from 100% to 94%, as measured with a pulse oximeter. ⋯ Pulmonary edema improved and the trachea was extubated 34 hours after surgery. Antibodies against HLA were detected in the RBC donor serum sample, and a crossmatch test between the patient lymphocytes and donor serum was positive. We concluded that perioperative transfusion of blood components has a potential to provoke serious TRALI.