Masui. The Japanese journal of anesthesiology
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The incidence of a tracheal bronchus supplying the right upper lobe has been reported to be in the range of 0.1 to 3%. We encountered 3 cases with the anomaly among 200 cases of lung surgery conducted over a year at our hospital. ⋯ Patients with a tracheal bronchus may be difficult or impossible to ventilate, especially when requiring unilateral lung ventilation. Therefore, the airway must be assessed carefully by fiberoptic bronchoscopy prior to unilateral lung surgery, keeping in mind the possibility of a tracheal bronchus, in order to design a safe way to secure it safely during the surgery.
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Case Reports
[Case of exostosis of the hard palate disturbing the insertion of Pro-Seal laryngeal mask].
We report a case of exostosis of the hard palate which had not bean ruled out in pre-operative examination and disturbed insertion of Pro-Seal laryngeal mask. The hard palate has canopy construction, and it is difficult to find this exostosis by routine physical examination. When we use Pro-Seal laryngeal mask, a careful inspection of the hard palate is indispensable.
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We studied the prevalence of postoperative complications and the predictor for the occurrence of postoperative delirium in patients who had received surgery for femoral neck fracture. ⋯ Our results indicate that it might be possible to prevent postoperative complications by careful perioperative management. Hearing loss preoperatively was a risk factor of postoperative delirium in advanced elderly patients.
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Case Reports
[Airway access using an endotracheal tube changer for safe extubation in an infant with a difficult airway].
We present a case where airway access was maintained using an endotracheal tube changer (ETC) after extubation in an infant with a difficult airway. A 4-month-old male infant with bilateral cleft lip and palate, micrognathia, schizencephaly, undescended testis, and abnormality of chromosomes 10 was scheduled for bilateral cleft lip repair. After anesthesia induction with thiamylal and vecuronium, we found that laryngoscopy was difficult (Cormack and Lehane grade III) despite external laryngeal compression. ⋯ The surgery was concluded uneventfully; but since endotracheal intubation had been difficult, special care was taken for extubation. We used an ETC for tracheal tube passing into the endotracheal tube at the time of extubation. Although using the ETC in infant with difficult airway for extubation remains controversial, we believe that for a difficult airway, even in an infant, a flexible ETC is a useful device for temporal airway access after extubation.
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In recent years, percutaneous tracheostomy has been performed in patients with adverse conditions such as short neck, obesity, coagulopathy or in emergency. ⋯ We believe that percutaneous tracheostomy in well-trained hands can be used safely for the management of the patient with a difficult airway.