Masui. The Japanese journal of anesthesiology
-
A 63-year-old man with von Recklinghausen disease was transported to the emergency department for swelling and pain of his right neck. Chest X-ray and computed tomography scan showed displacement of the trachea to the left by a tumor mass. Urgent airway management was required and fiberoptic intubation in awake condition was planned. ⋯ Suddenly, his consciousness level and Sp(O2) went down, therefore surgical airway was required. Due to pre-scanning, emergency cricothyroid membrane puncture could be performed immediately without any complications. We recommend ultrasound pre-scanning for cricothyroid membrane puncture in a patient with suspected tracheal displacement.
-
Case Reports
[Anchor Fast endotracheal tube securing device for a pediatric patient during therapeutic hypothermia].
A 5-year-old girl was admitted to our hospital after resuscitation from cardiac arrest due to near-drowning accident in a river. On admission, Glasgow Coma Scale score was 7; arterial blood pressure was 113/73 mm Hg; heart rate was 157 beats x min(-1), and percutaneous oxygen saturation was 99% on 10 l x min(-1) of oxygen. The patient was intubated with a 5.0 mm internal diameter endotracheal tube, and therapeutic hypothermia was started for neural protection. ⋯ Anchor Fast kept the tube position properly even though the patient was turned or moved. Seventy-two hours later, she was rewarmed and extubated as scheduled. Ten days after admission, she was discharged without any neurological deficits.
-
Comparative Study
[Safety of axillary and subclavian vein cannulation using real-time ultrasound guidance].
The safety of real-time ultrasound-guided subclavian and axillary vein cannulation as opposed to ultrasound-guided internal jugular vein cannulation has not received much attention. We retrospectively compared the safety and value of real-time ultrasound-guided cannulation in the subclavian and axillary veins with those of the landmark method. ⋯ Real-time ultrasound-guided subclavian and axillary vein cannulation is associated with a low incidence of complications similar to that of the internal jugular vein when competent individuals with appropriate training apply the technique.
-
A 68-year-old man was diagnosed with severe pharyngeal edema after neck lymph node dissection for cancer of the external ear canal. He was scheduled for an emergency tracheotomy, but preoperative fiberoptic laryngoscopy revealed airway and glottic obstruction due to severe pharyngeal edema. As difficult mask ventilation and tracheal intubation were anticipated, intubation under spontaneous ventilation was performed to avoid a "can't ventilate, can't intubate" situation. ⋯ Therefore, a size 3.5 air-Q intubating laryngeal airway was inserted using a bronchofiberscope to perform tracheal intubation through a laryngeal mask. Successful tracheal intubation was achieved while maintaining spontaneous ventilation. The air-Q intubating laryngeal airway can be useful in the setting of anticipated difficult mask ventilation and tracheal intubation, as in the case of severe pharyngeal edema.
-
A 21-day-old female neonate weighing 3.2 kg was scheduled for surgical excision of a maxillary tumor under general anesthesia. The lesion was present since birth, with gradual enlargement since then. Preoperatively, the lesion measured 25 mm in diameter, although it was not known whether it was benign or malignant. ⋯ The surgical procedure lasted for 27 minutes and at the end of the surgery we successfully intubated the patient's trachea with a spiral tube using a guide wire and bronchofiber. After adequate blood transfusion to restore the patient's blood volume, a nasogastric tube was inserted and the patient was extubated in a fully awake state with establishment of adequate spontaneous breathing. Postoperatively, histopathologic examination revealed that the tumor was a jawbone medullary hemangioma.