Masui. The Japanese journal of anesthesiology
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Case Reports
[Arytenoid cartilage dislocation caused by endotracheal intubation which resolved spontaneously].
Arytenoid cartilage dislocation following tracheal intubation is a rare complication. A 48-year-old man underwent an operation for laparoscopic cholecystectomy under general anesthesia. Although no anaesthetic or operative problem had occurred, hoarseness was noticed after the operation, continuing beyond 25 days thereafter. ⋯ About four weeks later, the arytenoid cartilage dislocation resolved spontaneously. Other findings suggest that spontaneous reduction can be expected in many patients with anterior arytenoid dislocation. Patients suffering from arytenoid cartilage dislocation should be observed for several weeks if possible because there exist some reports in the literature describing spontaneous resolution after its dislocation.
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Primary tracheal cancer is extremely rare, but critical tracheal stenosis is seen in many cases. Although laser resection or stent placement is performed under general anesthesia, anesthetic management for tracheal tumor is extremely difficult in terms of airway management. We report a 65-year-old woman scheduled to undergo bronchoscopic laser surgery and insertion of Dumon stent for tracheal tumor which severely obstructed the upper airway. ⋯ Although desaturation due to unsuccessful venous drainage and difficult ventilation by laryngeal edema during the operation and tracheal obstruction by a clot after the operation was observed, the patient's clinical condition improved. In cases of severe tracheal stenosis, airway obstruction by hemorrhage, secretion and laryngeal edema, etc. occur easily. Therefore, some kind of measures should be taken for the operation and a number of precautions must be taken during the perioperative period.
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Two patients with myasthenia gravis were scheduled for surgery. Anesthesia was managed with remifentanil and propofol target-controlled infusion without the use of muscle relaxants. ⋯ Throughout the surgery, muscle relaxants were not required. Thus, the use of these drugs for inducing anesthesia provided good conditions for tracheal intubation and surgery, and it precluded the need for muscle relaxants.
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We report a case of spinal myoclonus following cesarean section. The patient was a 34-year-old woman without history of neurologic disorders. In the operating room, after placement of an epidural catheter at T12-L1, bupivacaine 2.4 ml was administered intrathecally via a 25 G needle at L2-3. ⋯ The patient complained of involuntary jerky movements of her lower legs 195 min after the start of the spinal anesthesia. The sensory level was T12 and she could move her legs on command but could not stop her involuntary movements. The myoclonic movements ceased 150 min later without medication and did not reappear, despite restarting the epidural anesthesia with ropivacaine.
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The GlideScope video laryngoscope (Verathon Inc. Bothell, Washington, USA) is a relatively new device for tracheal intubation, which provides a excellent glottic visualization. We here report the clinical experience of the GlideScope (small) in 50 pediatric patients. ⋯ GlideScope seemed to be a novel device in pediatric patients. Further studies are required to evaluate the usefulness in neonates, small infants and children with a difficult airway.