Masui. The Japanese journal of anesthesiology
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Case Reports
[Anesthetic management of organ donation after brain death using continuous total hemoglobin measurement].
A 60-year-old woman declared brain dead was scheduled for organ donation. We continuously measured total hemoglobin values (SpHb) using a Radical-7 monitor (Masimo Co, Irvine, CA, USA) to maintain the functions of organs and oxygen delivery. At the start of surgery, the SpHb value was 9.3 g x dl(-1). ⋯ On cross-clamping of the aorta, the SpHb value increased up to 10.2 g x dl(-1). The heart, lungs, liver, pancreas, and kidneys were donated from the patient without organ dysfunction. The highlight of this case report is that anesthesiologists could use SpHb monitoring for management of hemodynamics in a brain-dead organ donor.
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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 2-month-old baby boy, 52 cm in height and weighing 4.6 kg, underwent a Blalock-Taussig shunt operation under general anesthesia. The authors checked the internal jugular vein (IJV) using an ultrasound apparatus with a 5/10-MHz probe (TiTAN, SonoSite Co., Tokyo, Japan) at a mid-portion of the neck. We observed a 3.9-mm-wide and 7.6-mm-deep IJV for central venous catheter (CVC) placement. ⋯ We placed the CVC into the left IJV instead of the right IJV. We speculated that the guidewire had advanced into the IJV; however, we could not advance the tip of the guidewire from the IJV to the brachiocephalic vein because the angle between the IJV and the brachiocephalic vein was 90 degrees. We could have advanced a J-type guidewire from the IJV into the brachiocephalic vein.
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The Pentax-AWS equipped with a new thinner blade (Introck-T) is an intubation device that provides a non-line-of sight view of the glottis. A non-line-of sight view is expected to cause less movement of the cervical spine during laryngeal visualization. We measured the degree of cervical spine movement during laryngoscopy with the device. ⋯ Laryngeal visualization using the Pentax-AWS with the new thinner Introck-T produces the anterior movement and extension of the cervical spine.