Masui. The Japanese journal of anesthesiology
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Meta Analysis
[Video Laryngoscopy Reduces the Incidence of Erroneous Esophageal Intubation: A Meta-analysis].
The aim of this meta-analysis is to compare the incidence of erroneous esophageal intubations by video laryngoscopy to that by direct laryngoscopy. ⋯ Our meta-analysis showed that video laryngoscopy would reduce the incidence of erroneous esophageal intubations.
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Both motor evoked potential (MEP) and somatosensory evoked potential (SEP) have been used for the purpose of preventing postoperative neurological complications in patients undergoing neurosurgery. Although not completely, they can detect insufficient cerebral blood flow during aneurysm surgery and carotid surgery and prevent functional deterioration during tumor resection. Regarding MEP, there are several points to be considered for maximizing the potential of MEP. ⋯ Although there is no such thing as 100% accuracy in electrophysiological monitoring, a multimodal electrophysiological monitoring system may contribute to decrease neurological deficits. Irreversible neurological deficits could be prevented by early detection of the changes in the amplitude and by prompt intervention to correct deteriorating condition. Therefore, it is important for anesthesiologists to select suitable anesthetics for the monitoring, maintain the depth of anesthesia, and discuss the patient management with surgeons.
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A 75-year-old woman suffering from respiratory difficulty was diagnosed with severe tracheal stenosis due o malignant thyroid cancer. She was scheduled for an mergent tracheotomy, but preoperative computed omography revealed severe tracheal stenosis below he glottis due to thyroid cancer invasion. ⋯ Successful tracheal intubation which avoided damage to the tumor was achieved while maintaining spontaneous ventilation. The air-Q intubating laryngeal airway was useful in this setting of severe tracheal stenosis due to thyroid cancer just under the glottis.
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We report the anesthetic management of microlaryngeal surgery in children using tubeless total intravenous anesthesia (TIVA) without endotracheal intubation under spontaneous breathing. In 9 patients (median age : 4.9 yr. range 1 months-14 years, body weight : 17 kg, range 3-61 kg), 19 procedures were performed with TIVA using propofol and remifentanil. The median time from the start of TIVA to rigid laryngoscope insertion was 11 minutes. ⋯ Three children were found apneic after a bolus administration of remifentanil or after increasing the rate of remifentanil infusion accompanied with desaturation and their tracheae were intubated. The spontaneous respiration technique using TIVA without intubation provides an excellent view of the operative field while allowing stable anesthesia. Further studies are required to establish the optimal dose of propofol and remifentanil and the timing of rigid laryngoscope insertion.
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Participation in the American Heart Association advanced cardiac life support provider course is a prerequisite for taking the anesthesiology specialist examination in Japan. The course teaches fundamental resuscitation methods for different types of cardiac arrest. ⋯ Main contents of the course included circulation management, airway management central venous catheters, and pain clinic-related complications. ALS-OP simulation training may be beneficial for educating anesthesiologist and promoting perioperative patient safety.