Masui. The Japanese journal of anesthesiology
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We report a case of sudden head-tilt difficulty after induction of general anesthesia which was postoperatively diagnosed as ossification of the posterior longitudinal ligament. A 42-year-old man weighing 115 kg was scheduled for emergent laparoscopic appendectomy for acute appendicitis. ⋯ Following mask ventilation with jaw-thrust maneuver, we successfully performed tracheal intubation using the Pentax-AWS Airwayscope. After surgery, he was diagnosed with ossification of the posterior longitudinal ligament by an orthopedist.
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The laryngeal tube (LT ; Smiths Medical, Minnesota, U. S. A) is an inflatable supraglottic device for emergency airway management such as during chest compression, the instability after insertion remains a problem. ⋯ A fixation neck tape may be useful in stabilizing the inserted position of LT during cardiopulmonary resuscitation.
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Intraoperative neurophysiological monitoring has been increasingly utilized for many neurosurgical procedures as well as for spine and aortic surgery. The recent advances in monitoring devices and anesthesia techniques have improved the reliability and accuracy of intraoperative neurological monitoring. In this issue, we review the basic principle, methods, and clinical application of several modalities of neurological monitoring to detect neural tissue ischemia and the direct physical injury to the specific neural pathway during surgical procedures. ⋯ Evidence for the efficacy of the monitoring varied with surgical procedures, but has been well validated in some procedures. Anesthesiologists can contribute to the reliability and efficacy of neurophysiological monitoring by maintaining good physiological homeostasis and stable levels of anesthesia during the surgical procedure. With appropriate knowledge and experience, the anesthesiologist should work together with the neuromonitoring staff and surgeon to ensure neurological safety for the patient during and after surgery.
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Comparative Study
[Comparison of Seven Intubation Devices in Difficult Airway Model].
The efficacy in tracheal intubation may differ between different video-optical devices, in particular in patients with difficult airways. The purpose of this study was to evaluate the efficacy of video-laryngoscopes and fiberoptic bronchoscope (FOB) in tracheal intubation on a mannequin with several difficult airways, including limited mouth opening, cervical spine rigidity and tongue edema. ⋯ Videolaryngoscopes can generally be useful in patients with all difficult airways, but may be difficult in some circumstances (such as tongue edema). The FOB provided good laryngeal view in all cases, but the success rate of tracheal intubation was low and the time to intubate trachea was long.
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Randomized Controlled Trial
[The Effect of Preoperative Oral Rehydration on Hemodynamic Changes during Induction of Anesthesia and Intraoperative Fluid Management].
Preoperative oral rehydration solution (ORS) prevents dehydration before surgery. Therefore taking enough ORS possibly reduces the hemodynamic changes during induction of anesthesia, and reduces the amount of fluid needed during anesthesia. ⋯ Preoperative oral rehydration increases circulating blood volume, it keeps high CI during induction of anesthesia, and reduces the amount of intraoperative fluid.