Masui. The Japanese journal of anesthesiology
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A 12-year-old girl with severe scoliosis underwent an operative procedure for correction of her spine deformity. Spinal cord injury is one of the most feared complications of scoliosis surgery. ⋯ We used an intraoperative wake-up test with the concept of target-controlled infusion and total intravenous anesthesia (propofol and remifentanil). The use of Bispectral Index monitoring as a measure of depth of anesthesia enabled the patient to awake rapidly and consequently we did an immediate evaluation of muscle strength of lower extremities.
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Case Reports
[Acute pulmonary edema in adult caused by tonsillar hypertrophy following removal of laryngeal mask airway].
Negative pressure pulmonary edema (NPPE) has been described after acute airway obstruction. In the following case, we observed a rare occurrence of pulmonary edema caused by chronic tonsillar hypertrophy in a woman following removal of laryngeal mask airway (LMA). A 38-year-old woman with breast cancer underwent mastectomy under general anesthesia using the LMA. ⋯ She was then intubated to secure airway and provide adequate ventilation with PEEP. Fortunately, the symptoms progressively remitted satisfactorily, and she was subsequently extubated 18 hours later with no complications. NPPE is an infrequent medical emergency and its early diagnosis and recognition are likely to lead to successful management of this potentially serious complication.
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The Airway Scope (AWS) is a video laryngoscope and there are some problems associated with its use in insertion of the tracheal tube despite its ability to view the glottis. For the purpose of improving the problems, we devised the tube introducer catheter (TIC) for use with AWS. ⋯ The TIC was significantly effective in facilitating tracheal intubation using the AWS in a manikin model.
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One-lung ventilation and lung isolation are frequently required in thoracic surgery. In clinical practice, lung isolation is achieved by use of a double-lumen endotracheal tube and a bronchial blocker. A novel bagel shaped bronchial blocker, the Fuggiano's bronchial blocker, has been designed to prevent displacement of the blocker from its position in the bronchus. In this study, we evaluated the clinical performance of the Fuggiano's bronchial blocker for the lung isolation. ⋯ We conclude that, for routine use, the Fuggiano's bronchial blocker is preferable to achieve a lung isolation because of its facility in placement and a better quality of lung deflation. Fuggiano's bronchial blocker may be an alternative airway device for one-lung ventilation, and further work is required.