Masui. The Japanese journal of anesthesiology
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The "BURP" maneuver (back, upward, right lateral, pressure) improves the visualization of the larynx for experienced anesthesiologists during orotracheal intubation in patients with difficult airway. We investigated whether this maneuver has same efficacy for inexperienced residents in anesthesiology. ⋯ We concluded that "BURP" maneuver was effective even for inexperienced residents. More than two months were required for the residents to develop laryngoscopy skill.
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Ketamine is associated with an increase in the bispectral index (BIS) values that can lead to an overdose of hypnotic agents. We investigated the effect of ketamine on BIS values during general anesthesia with a target-controlled infusion (TCI) of propofol and infusion of remifentanil. ⋯ Under stable propofol and remifentanil anesthesia, a small dose of ketamine did not increase the BIS value over the next 15 min.
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Dexmedetomidine (DEX) has analgesic, anxiolytic, and antidelirium effects, and causes little respiratory depression. Behavioral disturbances such as agitation, aggression, and sleep disorder are common in cognitive impairment; this impairment may be one of the risk factors for postoperative delirium. We studied the effects of postoperative DEX administration in elderly patients with cognitive impairment. ⋯ Low-dose DEX is safe and useful for postoperative sedation in elderly patients with cognitive impairment.
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Case Reports
[A case of endotracheal intubation in prone position utilizing PENTAX-Airwayscope for morbidly obese patient].
We experienced the airway management of a morbidly obese patient in prone position utilizing PENTAX-Airwayscope (AWS) which is a novel airway device for endotracheal intubation. A 29-year-old man, who was 150 kg in weight and 51.9 kg x m(-2) in body mass index, was scheduled for the discectomy for lumbar disc herniation. After the topical anesthesia with lidocaine spray, the patient lay on his stomach by himself on the table. ⋯ With the patient breathing spontaneously, we successfully inserted the reinforced endotracheal tube. After the maintenance of anesthesia with continuous infusion of dexmedetomidine, ketamin and remifentanil, the patient awoke clearly without pain and endotracheal tube was removed safely in the prone position. Although the prone position is not the standard position for endotracheal intubation under general anesthesia, our technique could be performed in emergency situations.
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Comparative Study
[How to improve positioning of the head--the sniffing position, considered to be suitable for endotracheal intubation].
The sniffing position, a combination of flexion of the neck and extension of the head, is considered to be suitable for the performance of endotracheal intubation. To place a patient in this position, anesthesiologists usually put a pillow under a patient's occiput. However, with a regular pillow, the resulting extension of the head tends to be suboptimal. ⋯ The triangular pillow improves the laryngoscopic view and facilitates endotracheal intubation by optimizing a patient's head position.