Masui. The Japanese journal of anesthesiology
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Case Reports
[A case of a patient with Forestier's disease--intubation by Airway Scope and bronchofiberscope].
Forestier's disease accompanies difficult airway management with the ossification of the anterior longitudinal ligament of the spine. The abnormalities include limited cervical mobility, constrained epiglottic elevation, exclusion of the part of aryepiglottic, recurrent nerve paralysis and thinning of respiratory tract mucosa. ⋯ We could intubate an enforced tube (internal diameter 7.5 mm) with the bronchofiberscope guidance without any complications. This procedure seems to be safe for intubation in a Forestier's disease patient.
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Most drugs used in practical pediatric anesthesia are off-label. Pediatric anesthesiologists and non-pediatric anesthesiologists who rarely encounter pediatric patients need to be aware of the clinical usage of these drugs based on pediatric pharmacokinetics and pharmacodynamics to ensure that children are not exposed to unnecessary risks. Clinical guidelines on anesthetic drugs have been made available on the Japanese Society of Anesthesiologists website, and anesthesiologists are encouraged to access this site at least once. ⋯ Rocuronium and sugammadex have been used safely in pediatric patients so far, and may change the induction methods used in difficult airway patients and the management of airway emergencies. Desflurane is novel in Japan and has not been commonly used in pediatric anesthesia. Desflurane may cause very high irritability in the airway and may be used for the maintenance of anesthesia in limited situations.
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Regional anesthesia has been widely applied as an excellent method for perioperative analgesia. Recent studies suggested that regional anesthesia is a promising approach to minimize the risk of surgical site infection and postoperative cancer recurrence, subsequently providing the benefits to the long-term outcome. ⋯ Besides, during the perioperative periods, tumor immunity is significantly depressed due to surgical pain, activation of sympathetic nervous system, inflammatory responses, and others. In this review article, we discuss the tumor immunity during the perioperative period, with focus on the alterations of tumor immunity and regional anesthesia.
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Recent advances in pediatric airway management contribute to a significant decrease in morbidity and mortality in pediatric anesthesia. This article reviews the current concept of routine and difficult pediatric airway with special emphasis on preoperative pediatric airway assessment. ⋯ Based on the pediatric protocol recently published by the Difficult Airway Society (DAS), we discuss structured algorithms for unanticipated difficult pediatric airway. Simulation technology will aid acquisition and retention of pediatric airway management skills.
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Perioperative fluid therapy aims to provide water, electrolytes and calorie to maintain metabolic homeostasis. The landmark article in which Holliday and Segar proposed the rate and composition of parenteral maintenance fluids for hospitalized children is used to the fluid management for the pediatric surgical patient. ⋯ Routine intraoperative dextrose administration is no longer necessary. We should ultimately change our approach according to major intraoperative fluid shifts by rational, monitored, goal-directed combination of both crystalloid and colloid therapy, similar to that occurring in adult surgical patients.