Masui. The Japanese journal of anesthesiology
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Meta Analysis Comparative Study
[Efficacy of Pentax-AWS in difficult airways: a meta-analysis of randomized controlled trials].
Increased evidence indicates that the Pentax-AWS (AWS) is useful for difficult airways. The aim of this meta-analysis was to assess the efficacy of the AWS in difficult airways, comparing that of Macintosh laryngoscopy. ⋯ There is considerable evidence that AWS has an advantage over Macintosh laryngoscope in difficult airways.
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A 60-year-old female with anti-phospholipid syndrome underwent amputation of her left lower limb. She had had a history of cerebral infarction, cerebral hemorrhage, coagulation abnormalities, thrombocytopenia, and pneumothorax, and just recovered from disseminated intravascular coagulation. After intravenous fentanyl 25 microg, ultrasound-guided sciatic, femoral and lateral femoral cutaneous nerve blocks were performed. ⋯ For femoral nerve block, a catheter was inserted and ropivacaine was infused at 4 ml x hr(-1) after surgery. Amputation at the left thigh was successfully performed and postoperative course was uneventful. The sciatic, femoral and lateral femoral cutaneous nerve blocks were useful for amputation of a patient with severe coagulopathy by anti-phospholipid syndrome.
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In most cases, an endotracheal tube (ETT) enters the right bronchus due to anatomical features of the trachea. The Parker Flex-Tip Tube (Parker tube) has a centered and tapered tip with a posterior facing bevel. Here, we report a case of accidental left bronchial intubation that may be associated with the tip design of the Parker tube. ⋯ To test this hypothesis, we conducted a simulation study using a standard airway mannequin. Intubation with a standard left-beveled ETT resulted in right bronchial intubation in all 20 trials, while 4 of the 20 Parker tubes entered the left mainstem bronchus. This investigation suggests that unintentional left bronchus intubation of the Parker tube may occur in the ordinary clinical setting if the tube is advanced beyond the carina.
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A 46-year-old man was diagnosed with descending colon cancer and was planned to undergo left hemicolectomy under general anesthesia. His body mass index was 42.6 and due to his small mouth and jaw, we anticipated difficult mask ventilation and tracheal intubation. ⋯ Then, we replaced the air-Q with an outside diameter 8.5 mm tracheal tube. This case was a successful use of the air-Q under moderate sedation for airway management in the setting of anticipated difficult mask ventilation and tracheal intubation.
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Case Reports
[A case of late drug-eluting stent thrombosis during postoperative period after 5 years of stent implantation].
Stent thrombosis during perioperative period is a critical complication for patients treated with drug-eluting stent (DES). We experienced a case of late DES thrombosis 5 years after initial implantation. A 48-year-old man with familial hyperlipidemia, angina pectoris and chronic pulmonary emphysema, was diagnosed with esophageal carcinoma, and scheduled for esophagectomy. ⋯ Emergent coronary angiography revealed re-stenosis of the right coronary artery treated with DES 5 years ago. At present, there was no definite guideline, on the management of DES during perioperative period. It is important for us to decide continuing antiplatelet therapy balancing the risk of stent thrombosis with surgical bleeding in each patient.