Masui. The Japanese journal of anesthesiology
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The annual surveys of critical incidents in Japanese Society of Anesthesiologists (JSA)-certified hospitals in 1999-2002 demonstrated that massive and critical bleeding was the major cause of intraoperative cardiac arrest leading to poor prognosis including death and permanent brain damage. The surveys also suggested that type-specific blood transfusion and emergent O-type blood transfusions were underutilized. ⋯ Five academic societies publicized the guidelines for management of critical bleeding in obstetrics in 2010. Each hospital is expected to make institutional emergency blood transfusion guidelines on the basis of the above guidelines in order to decrease the incidence of critical bleeding and to improve the prognosis of the patients with critical bleeding.
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Case Reports
[Suspected case of peripartum cardiomyopathy during perioperative period--a case report].
A 31-year-old primigravida was admitted for control of twin gestation and delivery. At 36-week gestation, an emergent cesarean section was performed under combined spinal-epidural anesthesia because of progression of PIH. Anesthetic course was uneventful until the operation was finished. ⋯ HELLP syndrome and DIC were also combined with PPCM, so intensive care was given to her from the 1st POD. Symptoms of heart failure were alleviated by furosemide and carperitide by the 12th POD. The EF increased to 58% on the 11th POD.
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We report a case of awake intubation utilizing Pentax-AWS Airwayscope in semi-sitting position. A 74-year-old man with myasthenia gravis and cervical disc hernia was scheduled for distal gastrectomy under general anesthesia. ⋯ With fentanyl bolus administration and lidocaine spray for laryngotracheal anesthesia, we performed awake intubation in semi-sitting position with AWS from cranial side. The patient did not buck during intubation and no hemodynamic change was observed.
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Goldenhar syndrome is associated with difficult airway due to the characteristic craniofacial anomalies such as hypoplasia of the mandible and molar bones. We present our method of fiberoptic intubation using two tracheal tubes for a girl with Goldenhar syndrome undergoing cochlear implant surgery. She had received general anesthesia for dental treatment one year before, but the treatment had been cancelled because of the failure of tracheal intubation. ⋯ After obtaining a stable anesthetic level, we inserted two tracheal tubes from the right and left nostrils, one for a tracheal tube and the other for a nasopharyngeal airway. During the procedure, the fiberscope was advanced through the tracheal tube with a slit connector, and her ventilation was assisted through the nasopharyngeal airway with her mouth closed by a tape to avoid a leak of ventilating gas. Using this two-tube method, we successfully intubated the trachea of a patient Goldenhar syndrome.
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Comparative Study
[Comparison of airway scope and videolaryngoscope portable VLP-100 in the presence of a neck collar--a manikin study].
Tracheal intubation should be performed with great care in the multiple injury patient, particularly when damage to the cervical spine is suspected. The patient with unstable cervical spine requires a neck collar in prehospital area, and medical personnel may be required to perform tracheal intubation. We compared Macintosh laryngoscope with the Airway Scope (AWS), and Coopdeck videolaryngoscope portable VLP-100 (VLP-100) in a manikin model with the presence of a neck collar. ⋯ The AWS may possess advantages over conventional direct laryngoscopes in patients with restricted neck movement.