Masui. The Japanese journal of anesthesiology
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Case Reports
[Case of exostosis of the hard palate disturbing the insertion of Pro-Seal laryngeal mask].
We report a case of exostosis of the hard palate which had not bean ruled out in pre-operative examination and disturbed insertion of Pro-Seal laryngeal mask. The hard palate has canopy construction, and it is difficult to find this exostosis by routine physical examination. When we use Pro-Seal laryngeal mask, a careful inspection of the hard palate is indispensable.
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We studied the prevalence of postoperative complications and the predictor for the occurrence of postoperative delirium in patients who had received surgery for femoral neck fracture. ⋯ Our results indicate that it might be possible to prevent postoperative complications by careful perioperative management. Hearing loss preoperatively was a risk factor of postoperative delirium in advanced elderly patients.
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Case Reports
[Airway access using an endotracheal tube changer for safe extubation in an infant with a difficult airway].
We present a case where airway access was maintained using an endotracheal tube changer (ETC) after extubation in an infant with a difficult airway. A 4-month-old male infant with bilateral cleft lip and palate, micrognathia, schizencephaly, undescended testis, and abnormality of chromosomes 10 was scheduled for bilateral cleft lip repair. After anesthesia induction with thiamylal and vecuronium, we found that laryngoscopy was difficult (Cormack and Lehane grade III) despite external laryngeal compression. ⋯ The surgery was concluded uneventfully; but since endotracheal intubation had been difficult, special care was taken for extubation. We used an ETC for tracheal tube passing into the endotracheal tube at the time of extubation. Although using the ETC in infant with difficult airway for extubation remains controversial, we believe that for a difficult airway, even in an infant, a flexible ETC is a useful device for temporal airway access after extubation.
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In recent years, percutaneous tracheostomy has been performed in patients with adverse conditions such as short neck, obesity, coagulopathy or in emergency. ⋯ We believe that percutaneous tracheostomy in well-trained hands can be used safely for the management of the patient with a difficult airway.
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A 56-year-old man with 3 coronary vessel disease (#5, HL, #13), underwent OPCABG. Anesthesia was induced with propofol (PRO), fentanyl and vecuronium, and maintained with continuous infusion of remifentanil (REM), PRO and vecuronium. After the revascularization of 3 vessels, we changed the infusion anesthetics from REM to dexmedetomidine (DEX), and 40 minutes later we extubated immediately after the operation in the operating room with no problems. ⋯ But this method, general anesthesia by combination of propofol-remifentanil-dexmedetomidine without epidural analgesia, was very stable in the operative period, and respiration was well maintained after extubation in the operating room. There were no critical hypercapnea, hypoxia, ventilatory problems and any cardiac complications. This method provided suitable conditions for maintenance and emergence of anesthesia, and enabled a shorter stay in ICU of below 24 hours.