Masui. The Japanese journal of anesthesiology
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Randomized Controlled Trial Comparative Study
[A comparison of the single-use i-gel with the reusable laryngeal mask airway Proseal in anesthetized adult patients in Japanese population].
The i-gel is a newly developed, cuffless and single-use supraglottic airway device with gastric drain conduit. This study was designed to compare the performance of the i-gel with the reusable LMA Proseal when used during anesthesia in spontaneously breathing adult patients. ⋯ Our result indicated that i-gel can be inserted faster without inserting practitioners' finger into patient oral cavity. Leak pressure was sufficient for clinical use in spontaneous breathing anesthetized adult patients.
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A patient developed upper airway obstruction immediately after tracheal extubation due to excessive anteflexion of the neck with occipitocervical fusion. A 59-year-old woman who had undergone mastectomy 17 years previously was scheduled for occipitocervical fusion for C2 vertebral metastasis. Retroflexion of her neck was restricted. ⋯ One day postoperatively, extubation was performed successfully with no dyspnea. Fixation of the neck in excessive anteflexion is one of the causes of upper airway obstruction after occipitocervical fusion. We must carefully observe cervical X-ray films to locate the upper airway obstruction, and careful extubation using a tube exchanger is strongly recommended in this operation.
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Case Reports
[Anesthetic management of a patient with pulmonary arterial hypertension undergoing caesarean section].
A 38-year-old woman on medical therapy for Basedow disease and hypertension with a history of recent heart failure became pregnant. At the 13th week of gestation, her echocardiography showed pulmonary hypertension with 63 mmHg of estimated systolic pulmonary arterial pressure. At the 26th week of gestation, she was admitted to our hospital with dyspnea and uncontrolled hypertension. ⋯ After epidural anesthesia had been established, surgical procedure was safely performed. The patient was discharged 9 days after surgery, and her estimated systolic pulmonary arterial pressure dropped to 35 mmHg on echocardiography 2 months after the operation. We speculate that pregnancy induced her severe pulmonary hypertension.
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An 84-year-old man successfully underwent thoracotomic drainage for empyema under awake epidural anesthesia. His past history had revealed significant chronic obstructive pulmonary disease due to smoking. ⋯ The additional small doses of fentanyl i. v. and local anesthesia infiltration were needed for resection of 9th rib, but otherwise the drainage was managed successfully. Awake epidural anesthesia was very useful for such a high-risk patient with poor respiratory status.
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Case Reports
[A case of postoperative convulsive seizure following tranexamic acid infusion during aortic valve replacement].
We present a case of postoperative convulsive seizure in an 84-year-old man who underwent an aortic valve replacement. The patient had hypertension associated with hyperaldosteronism and chronic interstitial nephritis. The duration of cardiopulmonary bypass was 74 min. ⋯ The blood sugar, sodium, and calcium levels were within the normal limits. The seizures were likely due to a total dose of 8 g of tranexamic acid (TXA) administered intraoperatively. Possible mechanisms of TXA-induced seizures include blockage of inhibitory cortical y -aminobutyric acid-A receptors.