Masui. The Japanese journal of anesthesiology
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Case Reports
[Two cases of preceded aortic valve replacement for severe aortic stenosis before the cancer operations].
We report two cases of aortic valve replacement (AVR) for severe aortic stenosis (AS) before the cancer operations. Severe AS poses a great risk for noncardiac surgery. In the ACC/AHA 2007 Guideline on Perioperative Cardiovascular Evaluation and Care for Noncardiac Surgery, if the AS is symptomatic, elective noncardiac surgery should generally be postponed or canceled. ⋯ In our cases the patients underwent the cardiac surgery and noncardiac surgery in a short period without serious complication in the perioperative management. It is very important to discuss among surgeon, cardiovascular surgeon, cardiologist and anesthesiologist. Especially anesthesiologist should take an important role in organizing these departments for such patients.
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Unrecognized esophageal intubation remains a significant cause of anesthetic morbidity. Extensive data showed that clinical signs and methods for confirming proper tracheal tube placement were not always reliable. Advancing tracheal tube into the trachea can be detected by palpating the cricoid cartilage. We evaluated the reliability of detecting tracheal intubation by cricoid palpation methods (CPM) in this study. ⋯ The CPM alone is imperfect for tracheal tube placement confirmation. Multiple methods for detecting correct tube placement should be used, since no single method has perfect reliability.
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Randomized Controlled Trial
[Preoperative intravenous administration of droperidol (1.25 mg) reduced postoperative nausea and vomiting after intrathecal morphine administration].
Intrathecal morphine (ITM) is an excellent postoperative analgesic, but may often cause postoperative nausea and vomiting (PONV). We designed this prospective, randomized and controlled study to evaluate the antiemetic efficacy of low-dose droperidol for the treatment of PONV caused by ITM. ⋯ Single intravenous administration of 1.25 mg droperidol before operation showed prophylactic efficacy in early PONV caused by ITM. The duration of droperidol action was shorter than that of ITM. Hence we recommend that droperidol should be administered more frequently or continuously in the postoperative period.
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We administered anesthesia for a 20-month-old boy with non-bullous ichthyosiform erythroderma who underwent orthopedic syndactyly repair on two occasions. Anesthetic considerations include the difficult fixation of the tracheal tube and iv cannulas and the risk of hypothermia. Intravenous access placement was also difficult due to the hyperkeratosis and the deformity of extremities. ⋯ To maintain body temperature we used forced air warming device Bair Huggar, which was very useful to avoid hypothermia but resulting in a rather high body temperature. In conclusion, a tube holder was an effective device to fix the tracheal tube in this patient. Forced air warming device was useful to prevent hypothermia.
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The aim of the present study was to evaluate the suitability of Airtraq optical laryngoscope for the tracheal intubation in children. ⋯ The Airtraq optical laryngoscope might be an alternative apparatus for endotracheal intubation in pediatric patients.