Masui. The Japanese journal of anesthesiology
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We experienced three cases of ventilatory difficulty through a Proseal laryngeal mask airway was encountered during general anesthesia using remifentanil and sevoflurane. General anesthesia was induced with propofol and maintained with remifentanil (0.2-0.25 microg x kg(-1) x min(-1)) and sevoflurane (1-1.5%). Increased airway pressure was noticed suddenly. ⋯ The inability to ventilate patients with opioids has been ascribed to increased thoracic wall rigidity or vocal cord closure or combination of both factors. In our three cases, the closure of vocal cord after remifentanil administration seems to be the major cause of difficult ventilation during general anesthesia. Therefore, supraglottic airway devices should be applied with caution during general anesthesia with remifentanil and sevoflurane without muscle relaxant.
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Case Reports
[Diagnosis of persistent left superior vena cava in a child using transesophageal echocardiography].
An 11-year-old boy with X-linked alpha-thalassaemia/ mental retardation symptom underwent gastrostomy. After the surgical procedure, insertion of a central venous (CV) catheter via the left subclavian vein was performed under X-ray radioscopy. However, the catheter did not move toward the right side of the heart shadow but descended caudally through the left side of the heart shadow. ⋯ Contrast echocardiography using infusion of agitated saline into the CV catheter was performed. Microbubbles flowing from the coronary sinus into the right atrium were observed, and a diagnosis of PLSVC was made. TEE is useful for diagnosis of PLSVC when passage of a CV catheter via the left subclavian vein or left internal jugular vein is incorrect in a pediatric patient.