Masui. The Japanese journal of anesthesiology
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Since the strict blood glucose control by intensive insulin therapy was introduced as a life-saving maneuver, a lot of beneficial effects have been reported. The intensive insulin therapy has also been recommended in cardiac surgeries, particularly with cardiopulmonary bypass (CPB) which often induces hyperglycemia resulting from the excessive stress response. ⋯ These studies indicated that the same target level of blood glucose did not provide the beneficial outcome to all patients, and that the optimal level of blood glucose differed depending on the individual patient and care setting. In order to determine the target level for blood glucose resulting in the lowest risk-to-benefit ratio, we must take into account various factors, such as variability of blood glucose concentration, presence or absence of diabetes, care setting, and perioperative nutritional management.
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Central venous catheterization using the Seldinger technique is a well known and often used method. On the other hand, there are also well known complications by needle puncture or by indwelling catheter, there are few reports about a guide wire which got hung up around the tricuspid valve. We report a case in which a guide wire got hung up to the chordae tendineae of the tricuspid valve. ⋯ There are many reports of the complication by the central venepuncture, but there are few reports about the guide wire which was entrapped in the vicinity of a tricuspid valve. The tip of the guide wire in this case was bent excessively, but the cause of the damage did not become clear by investigation. When a guide wire became hard to withdraw, we should never withdraw a guide wire blindly, but should search a cause and we should use the material which was matched with the cause.
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In the cases in which the flexibility of the patient's neck is limited, it is often difficult to achieve intubation. Fiberoptic intubation has been chosen for patients with arthroses. However, as it requires techniques, it has been difficult for inexperienced anesthesiologists. ⋯ Awake intubation using AirWay Scope for patients with cervical spinal diseases is a safe and useful anesthesia method. As dexmedetomidine causes no respiratory depression and can expect cooperation from patients, it may give safe and efficient sedation in awake intubation cases.
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Sore throat and hoarseness are common postoperative complications in patients who undergo tracheal intubation. In this study, we evaluated the severity of postoperative sore throat and the incidence of hoarseness in 60 patients after tracheal intubation. ⋯ In this study, VAS scores at the end of anesthesia and the next day were both significantly higher in the lubricated group than in others. Furthermore, there is no significant difference in VAS between the sprayed group and the no-intervention group. These data suggest that lidocaine jelly lubrication to the endotracheal tube reinforces the severity of sore throat. On the other hand, there was no significant difference in VAS between the sprayed group and the no-intervention group. This suggests that lidocaine sprayed to the trachea does not reduce postoperative sore throat.
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Case 1: A 41-year-old woman was scheduled for pinning of fractured finger and repair of a ligamentum. Preoperative problems did not exist except mandibular hypoplasia. General anesthesia was induced and Cormack classification was grade III in laryngeal view by laryngoscope and we tried a new videolaryngoscope PENTAX-AirWay Scope (AWS). ⋯ Ten minutes were needed to finish intubation due to difficult airway (Cormack classification grade III) when free latissimus dorsi flap reconstruction was perfomed two month before. Hence, AWS using a bronchofiberscope procedure was tried first and 39 seconds were needed to intubate. We concluded that AWS using bronchofiberscope procedure was useful for patients with difficult airway, though two anesthesiologist, one keeping AWS and the other using a bronchofiberscope, were needed.