Masui. The Japanese journal of anesthesiology
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We report a successful use of pediatric Airtraq optical laryngoscope in a pediatric patient with Robin sequence. Robin sequence accompanies a characteristic facies and its clinical presentation is marked by micrognathia, retrognathia, glossoptosis, and respiratory obstruction. ⋯ The Airtraq Pedi provided the glottic view with Cormack-Lehane grade I and a preformed tracheal tube (ID 4 mm) was placed correctly into the trachea through the built-in tube channel. We conclude that the pediatric Airtraq has potential advantages over conventional direct laryngoscopy in children with difficult airway.
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We describe the use of an abdominal aortic occlusion balloon catheter to control excessive blood loss at cesarean hysterectomy for placenta accreta. Prophylactic abdominal aortic occlusion balloon catheter was placed in the angiography suite under local anesthesia before surgery. The 38-year-old parturient was anesthetized with propofol, sevoflurane, ketamine, remifentanil and fentanyl under close monitoring and appropriate respiratory management. ⋯ Intraoperative blood loss was 1,800 g, and 300 g of autologous blood and 4 units of red cell concentrates were transfused. The postoperative course was uneventful. The present case suggests that prophylactic insertion of an aortic occlusion balloon catheter seems to be a safe and an effective method in controlling anticipated bleeding for caesarean hysterectomy in a parturient with placenta accreta.
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With the expanding elderly population in Japan, general anesthesia in patients above 80 years of age has become routine and is increasing. We report on a case of general anesthesia for a 100-year-old woman with chronic heart failure. ⋯ There was no cardiopulmonary instability during the operation, but heart failure became worse postoperatively, and it took nearly a month before the patient could leave the hospital. As for the operation and general anesthesia in the elderly, it is important not only to assess their perioperative physical risks but also to consider family background and postoperative course.
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Case Reports
[Case of airway management by laryngeal mask airway for a child with laryngeal web undergoing adenotonsillectomy].
We report a case of airway management by laryngeal mask airway (LMA) for a 4-year-old boy with laryngeal web undergoing adenotonsillectomy. Although the patient had no symptoms of airway stenosis, we detected a subglottic laryngeal web during the preoperative examination. The opening orifice of the laryngeal web was estimated to be too small for intubation, and we chose to manage the airway with LMA and spontaneous respiration. Using the LMA and Davis-Crowe mouth gag, we were able to provide the surgeon with the same exposure as with intubation while effectively managing the airway.
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Rapid and massive bleeding has to be counteracted by efficient volume restoration against rapid loss of intravascular volume. There are two phases of volume management for massive bleeding, uncontrolled phase and controlled phase. During initial uncontrolled phase, rapid infusion of crystalloid with RCC (red cell concentrate) is the first choice of volume management to prevent shock and profound decline of hemoglobin level. ⋯ A new generation of hydroxyethyl starch is a promising blood substitute, designed with minimum side effect. Although renal damage especially in septic patient and coagulation disorder are theoretically suspected, beneficial effect as volume expansion overwhelms these stochastic side effects. Since the side effect depends on the dose and how much it remains in the body, a purposeful use during volume expansion phase should be recommended.