Masui. The Japanese journal of anesthesiology
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The level of arterial carbon dioxide partial tension (PaCO2) is a sine qua non for the determination of the adequacy of ventilation. The aim of this study was to assess the usefulness of SenTec Digital Monitor System in measuring transcutaneous arterial carbon dioxide partial tension (PCO2) non-invasively for the management of chronic respiratory failure. ⋯ SenTec Digital Monitor System enables non-invasive and reliable trend monitoring of PCO2 levels in patients with chronic respiratory failure.
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Although percutaneous dilatational tracheostomy (PDT) is fast becoming the method of choice for securing an airway in chronic ventilated patients in an intensive care unit (ICU). Subcutaneous emphysema is an unusual and sometimes lethal complication which may extend the length of stay in the ICU. We report a case of massive subcutaneous emphysema without tracheal wall laceration that occurred in the ICU after PDT. ⋯ No pneumothorax was identified on subsequent chest X-ray. Laryngoscopic and bronchoscopic examination showed no evidence of tracheal wall laceration. We discuss the etiology and management plan for this rare complication.
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Case Reports
[Successful nasal intubation using airway scope with gum elastic bougie in a case of difficult airway].
AWS (Airway Scope, Pentax, Tokyo), a new videolaryngoscope, was originally designed to facilitate oral laryngoscopy and tracheal intubation. We describe a successful case of nasal intubation with a combination of AWS and GEB (gum elastic bougie). A 50-year-old man with a past history of difficult intubation was scheduled to undergo subtotal esophagectomy. ⋯ Oral insertion of AWS showed full view of the glottis and nasal insertion of GEB was easily advanced into the trachea through an endotracheal tube, allowing tracheal intubation while utilizing GEB as a stylet. No complication occured in this case. In conclusion, nasal intubation using AWS combination with GEB is useful for patients with difficult airways and is easy to perform.
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Lidocaine is frequently used as a local anesthetic and has very low incidence of serious complications. I report on a case of lidocaine intoxication in a 66-year-old man who presented with seizure and cardiac periarrest following the brachial plexus block with 450 mg of lidocaine. ⋯ Bradycardia and subsequent cardiovascular depression were found 74 minutes after the lidocaine block. The patient was successfully treated with diazepam, atropine sulphate and transcutaneous pacing for each symptom, respectively.
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Case Reports
[Anesthetic management of a pediatric patient with Beckwith-Wiedemann syndrome accompanied by macroglossia].
We report the anesthetic management of an infant with Beckwith-Wiedemann syndrome having massive macroglossia and umbilical hernia. Umbilical hernia repair and tongue reductions were performed under general anesthesia. ⋯ After the operation, mechanical ventilation was required for three days because of airway obstruction by secretions in the mouth and her edematous tongue. She had no complications and the postoperative course was uneventful.