Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Comparative Study
[Use of gum elastic bougie for tracheal intubation: comparison of different tracheal tubes].
Gum elastic bougie (GEB) is one of the most useful devices for patients whose tracheas are difficult to intubate during anesthetic induction. But no previous study has evaluated the effects of the types of the tracheal tube. We hypothesized that wire-reinforced tracheal tubes were superior to standard tracheal tubes in the success rate of tracheal intubation when using GEB. We compared these two different types of tracheal tubes in using GEB. ⋯ The type of tracheal tube would not affect the success rate and time of intubation when using gum elastic bougie.
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Case Reports
[Anesthetic management of a patient with transfusion-related acute lung injury (TRALI)].
Transfusion-related acute lung injury (TRALI) is characterized by pulmonary edema and hypoxemia within 6 hours of transfusion in the absence of other causes of acute lung injury or circulatory overload and is now considered the leading cause of transfusion-related death. We report a female patient who showed hypoxemia after transfusion without any other causes of acute lung injury. The patient is a 43-year-old woman, who received emergency transurethral hemostasis for bladder hemorrhage with hematuria and low hemoglobin concentration (3.2 g x dl(-1)). ⋯ The next day, hypoxemia was improved under PEEP therapy. The anti-HLA antibody in the transfused plasma was positive. We conclude that the early recognition and management of TRALI is essential during and after operation.
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A patient having an anti-acetylcholine receptor (AChR) antibody without myasthenia gravis was scheduled for thymectomy. Neuromuscular blockade monitoring showed a normal response to vecuronium in the patient. This finding suggests that sensitivities to neuromuscular blocking agents in the patients depend not on the titers of the antibody but also on the presence or absence of the preoperative symptoms such as muscle weakness. It is, however, recommended that neuromuscular blocking agents should be administered carefully under monitoring the neuromuscular function, as is the case for myasthenia gravis, because little is understood about the effect of neuromuscular blocking agent on the neuromuscular function in the asymptomatic patients having anti-AChR antibody.
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Intravenous leiomyomatosis (IVL) is an uncommon neoplasm characterized by the growth of a benign-looking smooth muscle tumor into the venous system. Intracardiac extension of this tumor is rare and may be misdiagnosed as right atrial myxoma unless the extracardiac part of the tumor is fully evaluated. ⋯ Intraoperative transesophageal echocardiography (TEE) revealed that the tumor had an extracardiac origin, resulting in tumor removal from the heart chamber and a part of the inferior vena cava (IVC) under circulatory arrest. When the findings of no attachment of the tumor to the interatrial septum or the right atrial wall and the tumor extension through the IVC are obtained by TEE examination, IVL should be considered as a differential diagnosis.
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Comparative Study
[Training of internal jugular vein cannulation: comparison of landmark method with ultrasound-guided method].
We compared training of internal jugular vein cannulation with ultrasound-guided method and that with landmark method in a group of 10 residents and that of 10 staffs. Cannulation was increasingly successful with both methods as the training proceeded, and with increasingly less time and fewer number of punctures. There was no statistically significant difference in time or in number of punctures with ultrasound-guided method between the groups. Ultrasound-guided method needed fewer number of punctures than those with landmark method in both groups.