Masui. The Japanese journal of anesthesiology
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Two recently recognized issues are reviewed ; one is a hospital acquired hyponatremia in children treated with intravenous hypotonic maintenance fluids and the other is the pros and cons of glucose addition to these fluids. Children in the perioperative period are at risk for nonosmotic secretion of ADH and stress-induced insulin resistance, which necessitate reducing the volume of maintenance fluid to half the previously recommended volume, and the concentration of additive glucose to approximately 2%. While isotonic fluids are recommended intraoperatively, controversies still exist on the constitution of maintenance fluids in the postoperative period, where the choice of an isotonic solution should be more pertinent to that of a hypotonic solution, but evidence is weak ; further investigations are needed to make a decision.
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Uncuffed endotracheal tubes have been commonly used in pediatric patients, but cuffed pediatric endotracheal tubes are recently introduced and stirred up a controversy. Uncuffed tubes may require multiple laryngoscopies, pollute the environment, and cause pulmonary aspiration as well as unstable ventilation. A recent study revealed that the contours of the airway and the tracheal tube are different, so that the pressure exerted on some parts of the cricoid mucosa may not be appropriate. ⋯ It is also used for a conduit for fiberoptic intubation and emergent airway with patients in the prone position. The lightwand (Trachlight) is another device for pediatric intubation and is recommended as the first-line option in patients who can be ventilated but in whom laryngoscopic intubation has failed. AirWayScope (Pentax-AWS) is a novel intubation device which combines an airway, camera and monitor It can be an epoch-making intubation device for infants and children if a smaller size is available in the future.
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Intracranial subdural hematoma (SDH) following dural puncture (DP) is a life-threatening complication. However, the characteristics and prognosis are little-known. ⋯ Seventy per cent of SDH occured following anesthesia related procedures. Most of them had an onset within one month after DP The prognosis was relatively good as long as SDH could be diagnosed at its early stage. It was necessary to observe the disappearance of postural headache and associated symptoms carefully to avoid delayed diagnosis.
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Comparative Study
[Pentax-AWS improves laryngeal view compared with Macintosh blade during laryngoscopy and facilitates easier intubation].
The PENTAX-AWS (AWS), combined with PBLADE is a novel tracheal intubation device which allows indirect visualization of the vocal cords without the alignment of the oral, pharyngeal axes required for direct laryngoscopy. Intubation procedure can be monitored on a built-in CCD monitor. ⋯ We conclude that the PENTAX-AWS provides a better laryngeal view than the Macintosh laryngoscope and facilitates easier intubation under vision in a higher proportion of patients.
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The incidence of nerve injury associated with epidural/spinal anesthesia has not been sufficiently investigated in Japan. ⋯ The incidence of nerve injury caused by regional anesthesia in Japan seems to be comparable to those reported in the developed countries. To reduce the incidence of this complication, cautious evaluation of the risk/benefit balance in performing regional anesthesia, improving education and supervision of the procedures, and establishing better communication between anesthesiologists and surgeons concerning the timing of catheter removal and the postoperative coagulation state seem to be important.