Masui. The Japanese journal of anesthesiology
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We describe the clinical use of a new video-laryngoscope (GlideScope, GS) in patients with a difficult airway and morbid obesity. In 4 patients with a difficult airway, showing a Cormack-Lehane grade III view with Macintosh direct laryngoscope, the glottic opening (Cormack-Lehane grade I or II) was visualized with GS. ⋯ GS also provided a good view of glottic opening in a patient with morbid obesity. GS will have a profound impact on the management of the difficult airway.
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An AirWay Scope (AWS, PENTAX Corporation, Tokyo, Japan) is a video-laryngoscope with a built-in LCD monitor used for tracheal intubation, while INTLOCK (PENTAX Corporation) is a specialized laryngoscope blade that encases the tip of AWS. The characteristic shape of INTLOCK fits the oropharyngeal anatomy and enables even less experienced operators to obtain an optimal view during tracheal intubation procedures, although it is limited to tracheal tubes of less than 11.5 mm outer diameter. Therefore, AWS is not suitable for double-lumen endobronchial tube (DLT) insertion. To resolve this issue, we developed modified INTLOCK for DLT insertion in cooperation with PENTAX, in which a portion of the tube guide was removed. ⋯ We were able to insert DLT in all subjects using modified INTLOCK without serious complications. The results indicate the usability of the device.
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Noninvasive positive pressure ventilation (NPPV) has recently been applied to patients with left ventricular dysfunction. We report a female patient who showed low cardiac output syndrome and pulmonary hypertension after cardiac surgery. After tracheal extubation, she developed cardiogenic pulmonary edema associated with an increase in extravascular lung water (EVLW). ⋯ However, once we weaned her from NPPV EVLW increased and pulmonary edema was revealed. On post-operative day 9, we finally weaned her from NPPV when baseline value of EVLW became small, probably due to supportive therapy including afterload reduction. We suggest that, in patients with left ventricular dysfunction, NPPV should be considered and EVLW may be a useful parameter to adjust the support.
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Spinal hematoma is a rare and serious complication anesthesia. Risk factors for spinal hematoma during neuraxial anesthesia are anatomic abnormalities, impaired hemostasis and difficult needle placement. ⋯ In order to reduce the risk of spinal hematoma in patients receiving heparin, it is recommended that the needle placement and catheter removal should be done when the anticoagulant effect of heparin is at the minimum. Postoperative evaluation of the neurological status is also important for early detection of a spinal hematoma.
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Knowledge and information were acquired from the results of the annual perioperative pulmonary thromboembolism (PPT) research from 2002 to 2004 by the Japanese Society of Anesthesiologists. Due to the popularization and use of prophylaxis, perioperative pulmonary thromboembolism (PPT) decreased significantly in 2004 compared to the years 2002 and 2003 (P < 0.001). The types of surgery with the highest incidence of PPT were hip/extremity surgery (7.48 per 10,000 cases), spinal surgery (6.30 per 10000 cases) and laparotomy (5.32 per 10,000 cases). ⋯ The proportion of obese men (20-40 yrs) with PPT was 2 fold higher, and in women (20-50 yrs) it was three fold higher, than that of the general population. In our investigation, the mortality rate of the PPT patient without prophylaxis was significantly higher than that of the patient with prophylaxis (P < 0.01). The predictive factors for death in our logistic regression were male gender, immobility, and lack of prophylactic treatment.