Masui. The Japanese journal of anesthesiology
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Angelman syndrome is a hereditary disease described by Angelman. The clinical features of Angelman syndrome are characterized by mental retardation, puppet-like ataxia, easily excitable personality, seizures, paroxysmal laughter, strabismus and macroglossia. A 4-year-old girl with Angelman syndrome underwent strabismus repair under general anesthesia. ⋯ Tracheal intubation was performed after administration of rocuronium. During and after anesthesia, no adverse events regarding circulatory and respiratory systems occurred. However, this case demonstrates that it is necessary to pay attention to airway troubles including the difficulty of tracheal intubation, management of body temperature and chronotropic action or respiratory depression by anesthetic agents.
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Lingual tonsillar hyperplasia is rare, but may cause difficult or impossible tracheal intubation. We administered anesthesia to a female patient with a body mass index (BMI) of 47 kg x m(-2) with unexpected lingual tonsillar hyperplasia. A 32-year-old woman was scheduled for surgery to repair a ventral hernia under general anesthesia. ⋯ We replaced the LMA with an intubating laryngeal mask airway (ILMA) for the purpose of tracheal intubation. Finally, the patient's trachea was intubated by ILMA with fiberoptic bronchoscopy. Several methods for tracheal intubation for the patients with lingual tonsillar hypertrophy have been reported; the insertion of an ILMA might be considered for safe airway management in combination with a fiberscope.
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It has been reported that postanesthetic shivering is associated with general anesthesia using remifentanil infusion. The aim of this retrospective study was to evaluate the factors leading to postanesthetic shivering. ⋯ These data suggest that fentanyl concentration may be important for avoiding postanesthetic shivering and the duration of surgery may be a predictor for postanesthetic shivering.
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Craniotomy sometimes causes pseudoankylosis of the mandible, i.e., limited mouth opening, leading to a difficult airway. We describe a case of difficult airway due to pseudoankylosis of the mandible after craniotomy, in which orotracheal intubation was successfully performed with an AirWay Scope (AWS). A 60-year-old woman was scheduled for clipping of an unruptured cerebral aneurysm. ⋯ After careful induction with fentanyl and propofol, the blade was inserted smoothly. Her glottic opening was easily visualized, and her trachea was intubated without any difficulty or any distinct hemodynamic disturbance. Careful assessment of the interincisor distance is essential in patients who have previously undergone craniotomy.