Masui. The Japanese journal of anesthesiology
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We describe the clinical use of a new video-laryngoscope (McGRATH MAC, McG) in patients with a difficult airway and morbid obesity. In a patient, case no. 2, with a difficult airway, showing a Cormack-Lehane grade III view with Macintosh direct laryngoscope, the glottis opening (Cormack-Lehane grade I) was visualized with McG. McG also provided a good view of glottis opening in a patient with morbid obesity. McG will have a profound impact on the management of the difficult airway.
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We retrospectively reviewed intraoperative hemodynamics, infusion volume, urinary output and dose of circulatory drugs in patients undergoing cholecystectomy in 3 types of anesthesia group: General anesthesia (GA group), general anesthesia with epidural anesthesia (EPI group) and general anesthesia with transversus abdominis plane (TAP) block (TAPB group). TAP block was performed using ultrasound-guided subcostal method and 20-30 ml of ropivacaine (0.2-0.3%) was injected to TAP bilaterally. Though, the blood pressure in TAPB group was lower than that in GA group, the degree of low blood pressure was smaller than that in EPI group. Less changes in intraoperative blood pressure, infusion volume and dose of phenylephrine in TAPB group compared to those in EPI group can be the advantage of TAP block alternative to epidural anesthesia.
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A 71-year-old female developed upper airway obstruction due to flexed cervical position after posterior occipito-cervical fusion. After the operation, she was re-intubated with the air-Q intubating laryngeal airway. ⋯ From the retrospective radiographic analysis, we suggest that the decrease of 18 degrees in the O-C2 angle causes the upper airway obstruction. On the extubation after occipito-cervical fusion, we should take care of the possibility of re-intubation and its difficulty based on the O-C2 angle.
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The aim of this case series was to evaluate the performance of GlideScope AVL single-use video laryngoscope for the visualization of the glottis and endotracheal intubations. ⋯ GlideScope AVL single-use video laryngoscope could be an effective aid for airway management in surgical patients.
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General anesthesia was successfully performed in a 9-year-old boy with FOP. FOP is a very rare inherited disease of the connective tissue, characterized by progressive heterotopic ossification of skeletal muscles, tendons, and ligaments. Trauma and invasive medical procedures can induce heterotopic ossification. ⋯ Regarding the airway management in general anesthesia, excessive stretching of the jaw and extension of the head may lead to the ankylosis of the temporo-mandibular joint and the neck stiffness. Ankylosis of the costvertebral joints induces restrictive ventilatory impairment, which causes atelectasis and lung infection in the perioperative period. Relating to anesthetic management for a child with FOP, anesthesiologists should keep in mind the prevention of exacerbation of the symptoms and subsequent impairment of activities of daily living postoperatively.