Masui. The Japanese journal of anesthesiology
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Case Reports
[Successful use of i-gel in three patients with difficult intubation and difficult ventilation].
I report successful ventilation through the i-gel and tracheal intubation through it, in patients in whom both facemask ventilation and tracheal intubation were difficult. Case 1: A 54-year-old woman, 157 cm, 60 kg, was scheduled for laparoscopic cholecystectomy. Preoperatively, neither difficult intubation nor difficult mask ventilation was predicted. ⋯ Insertion of a size 3 i-gel allowed adequate ventilation. Fiberoptic tracheal intubation through the i-gel was successful. I feel that the i-gel has a potential role as a rescue device, by allowing ventilation and tracheal intubation in patients with difficult airways.
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Either suprarenal or infrarenal aortic clamping markedly reduces renal blood flow. This aortic clamping may cause postoperative acute kidney injury(AKI). ⋯ AKI occurred in 24.1% of patients undergoing AAA surgery. Risk factors for AKI were preoperative Cre, operation time, clamp time and use of diuretics.
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We describe a case of bilateral obturator neuropathy after caesarean section. A 33-year-old woman expecting her first baby had rotational acetabular osteotomy 8 and 9 years ago. ⋯ Rotational acetabular osteotomy is known as one of the causes of narrow mid-pelvis diameter and it raises probability of caesarean section. Contracted pelvis may cause obturator neuropathy after delivery and we need to exclude complications by epidural blockade.
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Transcranial muscle evoked potential (TC-MsEP) monitoring is available to assess spinal cord motor tract function for preventing paralysis in spine surgery. Recently, the quality of monitoring has improved. However, adverse events such as torn tracheal tube, bitten tongue, and mandibular fracture are reported. ⋯ It seems that two adverse events were due to excessive masseter muscles contraction with TC-MsEP monitoring. Prevention for bite injury and ventilation strategy for tube occlusion or stenosis using Multipulse D-185 for TC-MsEP are necessary.
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We described a case of ventricular fibrillation in patients with Brugada type electrocardiogram (ECG) during surgery. A 63-year-old man underwent lung lobectomy under combined general and epidural anesthesia. His preoperative ECG showed Brugada type, but he was asymptomatic and did not have a family history of sudden death. ⋯ Previous report describes that the incidence of vasospasm in Brugada type ECG cases is relatively higher than those with the normal ECG. In addition, ventricular fibrillation might be induced by local anesthetics because these agents were administrated 10 minutes before the few events and balance of autonomic nervous system was changed. We conclude that strict monitoring and immediate treatment for ventricular fibrillation are important for anesthetic management in asymptomatic patient with Brugada type ECG.