Masui. The Japanese journal of anesthesiology
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Case Reports
[Emergency Tracheal Intubation Using Airwayscope in a Patient with Hematoma after Thyroidectomy].
We report a case of emergency awake intubation using Airwayscope (AWS) in a patient with difficulty of the ventilation combined with severe neck swelling due to hematoma after thyroidectomy. A 28-year-old woman with thyroid tumor received, general anesthesia induced, easily with facemask ventilation and tracheal intubation. Her trachea was extubated after she had become awake. ⋯ While we asked surgeons to prepare for emergency surgical tracheotomy, we attempted to intubate the trachea using the AWS under sedation. Despite difficulty in opening the mouth and swelling of the tongue, we managed to intubate the trachea. We consider that knowledge of difficult airway management (DAM) is necessary, but we must be flexible to judge which method should be used in each patient In addition we conclude that the AWS is useful for awake intubation.
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Clinical Trial
[Postoperative Analgesia in Peritonectomy for Patients with Peritoneal Surface Malignancy].
We investigated the efficacy of postoperative analgesia in peritonectomy for patients with peritoneal surface malignancy, by comparing peripheral nerve block (PNB) with intravenous patient controlled analgesia (iv-PCA) group to patient controlled epidural analgesia (PCEA) group. ⋯ PNB+iv-PCA decreased the rate of administration of flurbiprofen as compared to PCEA for postoperative pain after peritonectomy.
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We evaluated whether using thromboelastometry and tranexamic acid influenced blood loss and transfusion requirements in cardiac surgery requiring cardiopulmonary bypass. ⋯ The use of ROTEM and tranexamic acid can potentially reduce blood loss and transfusion requirements in cardiac surgery.
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Using an algorithm by which the effect-site concentration of propofol (esTEC) necessary for BIS level set from information input from BIS monitor and TCI pump is estimated, the effect of remifentanil on esTEC was investigated. ⋯ A mutual interaction was observed between propofol esTEC and remifetanil. For anesthetic management with less variation in BIS levels, it was considered that 10 ng x ml(-1) or higher of the effect-site concentration of remifetanil would be necessary.
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The bifurcation into tibial nerve and common peroneal nerve is generally targeted for sciatic nerve block at popliteal approach. However, it is sometimes difficult to determine the exact bifurcation point in clinical situation. The mean distance between the popliteal fossa and division of sciatic nerve (DPDSN) was reported approximately 6 cm ± 2.5 cm in Caucasian cadaver study. We also studied DPDSN in Japanese cadaver to find ethnic difference. ⋯ DPDSN of Japanese cadaver is shorter than the previously reported data in Caucasian cadaver. Since the DPDSN has inter-individual and intra-individual differences, we should estimate the DPDSN carefully in each leg using ultrasonography and nerve stimulator.