Masui. The Japanese journal of anesthesiology
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Case Reports
[The intubating laryngeal mask for a patient with cerebrospinal fluid rhinorrhea and pneumocephalus].
A 53-year-old male was scheduled for repairs of cerebrospinal fluid (CSF) rhinorrhea and pneumocephalus under general anesthesia. He had undergone a neck clipping for a ruptured anterior communicating aneurysm 13 days before. ⋯ A 7.0 mm ID straight silicone reinforced tube was then inserted through the ILM using a fiberscope. A fiberscope guided tracheal intubation via the ILM is recommended for patients with CSF rhinorrhea and pneumocephalus especially when the trachea is difficult to intubate under direct laryngoscopy.
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Case Reports
[A case of re-expansion pulmonary edema after one lung ventilation for the radical operation of lung cancer].
A 64-yr-old man was admitted to our hospital for the examination of the abnormal shadow in his left lung field, which was diagnosed later as lung cancer. Radical operation was scheduled under combined epidural/general anesthesia. One lung ventilation was performed to facilitate the operative procedure for two hours and fifteen minutes. ⋯ Re-expansion pulmonary edema seldom occurs in one lung anesthesia. Although radical operation of esophageal cancer performed six years before might have induced the development of re-expansion pulmonary edema in our case, complete collapse with quick re-expansion of the lung is clearly a potential risk of re-expansion pulmonary edema. Careful management is necessary after one lung ventilation.
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We experienced 22 consecutive anaesthetic managements requiring one-lung ventilation for thoracotomy. We used our original connector, which enabled us to insert a bronchial blocker cut from Univent tube and fibreoptic bronchoscope into the single lumen tracheal tube without air leakage and instability. The bronchial blocker was easily introduced into the mainstem bronchus of the non-dependent lung. ⋯ When one-lung ventilation was finished during surgery, we removed the bronchial blocker with connector, and could insert a larger fibreoptic bronchoscope and a suction catheter into the single lumen tracheal tube. We could detach or exchange the bronchial blocker, when they are not functioning well. This method was excellent in the airway management for usual thoracotomy.
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Randomized Controlled Trial Comparative Study Clinical Trial
["Tube scratching" in the trachea on nasotracheal intubation: comparison of Macintosh and McCoy laryngoscopes].
"Tube scratching" in the trachea, the intratracheal resistance of a tube, on nasotracheal intubation was evaluated using the Macintosh and the McCoy laryngoscope blade. ⋯ An excessive lifting of the epiglottis, often observed in using McCoy laryngoscope, causes "Tube scratching" in the trachea on nasotracheal intubation.
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Randomized Controlled Trial Clinical Trial
[The effects of colloid preload on hemodynamics and plasma concentration of atrial natriuretic peptide during spinal anesthesia in elderly patients].
We evaluated the effects of moderate colloid preloading on hemodynamics and plasma concentration of atrial natriuretic peptide (ANP) during spinal anesthesia in elderly patients undergoing low extremity surgery. Twenty patients (aged 66-90 yr) were randomly divided into two groups. ⋯ The concentration of ANP decreased significantly by 23% in control group, whereas it increased significantly by 86% in hydration group, suggesting that cardiac preload might increase with volume expansion effect of prehydration with HES. In conclusion, colloid preloading with moderate volume might prevent the decrease in cardiac preload with increasing ANP, whereas it did not prevent spinal-induced hypotension in elderly patients.