Masui. The Japanese journal of anesthesiology
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A 64-year-old man was scheduled for radical sinus operation. Preoperatively, we did not expect difficult airway. ⋯ We removed i-gel and fiberscope, leaving the AIC in place, and could easily advance a reinforced tube over the AIC into the trachea. Fiberoptic tracheal intubation via the i-gel and AIC is useful in a patient with difficult intubation.
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We report the anesthetic management of microlaryngeal surgery in children using tubeless total intravenous anesthesia (TIVA) without endotracheal intubation under spontaneous breathing. In 9 patients (median age : 4.9 yr. range 1 months-14 years, body weight : 17 kg, range 3-61 kg), 19 procedures were performed with TIVA using propofol and remifentanil. The median time from the start of TIVA to rigid laryngoscope insertion was 11 minutes. ⋯ Three children were found apneic after a bolus administration of remifentanil or after increasing the rate of remifentanil infusion accompanied with desaturation and their tracheae were intubated. The spontaneous respiration technique using TIVA without intubation provides an excellent view of the operative field while allowing stable anesthesia. Further studies are required to establish the optimal dose of propofol and remifentanil and the timing of rigid laryngoscope insertion.
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Meta Analysis
[Video Laryngoscopy Reduces the Incidence of Erroneous Esophageal Intubation: A Meta-analysis].
The aim of this meta-analysis is to compare the incidence of erroneous esophageal intubations by video laryngoscopy to that by direct laryngoscopy. ⋯ Our meta-analysis showed that video laryngoscopy would reduce the incidence of erroneous esophageal intubations.
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Both motor evoked potential (MEP) and somatosensory evoked potential (SEP) have been used for the purpose of preventing postoperative neurological complications in patients undergoing neurosurgery. Although not completely, they can detect insufficient cerebral blood flow during aneurysm surgery and carotid surgery and prevent functional deterioration during tumor resection. Regarding MEP, there are several points to be considered for maximizing the potential of MEP. ⋯ Although there is no such thing as 100% accuracy in electrophysiological monitoring, a multimodal electrophysiological monitoring system may contribute to decrease neurological deficits. Irreversible neurological deficits could be prevented by early detection of the changes in the amplitude and by prompt intervention to correct deteriorating condition. Therefore, it is important for anesthesiologists to select suitable anesthetics for the monitoring, maintain the depth of anesthesia, and discuss the patient management with surgeons.
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Here we report our success in performing lateral approach tracheal intubation in a patient with severe respiratory failure due to septic shock caused by shoulder joint abscess. A 71-year-old woman presented with severe respiratory difficulty due to sepsis from a shoulder joint abscess and was scheduled for emergent drainage and irrigation. She could not breathe sufficiently in the supine position and thus maintained a semi-sitting position. ⋯ Mask ventilation was performed using the two-hand technique from the lateral approach. Tracheal intubation was also performed with a left lateral approach utilizing the Pentax-AWS Airwayscope (AWS). Lateral approach for tracheal intubation utilizing AWS may be useful in patients who present with severe respiratory difficulty.