Masui. The Japanese journal of anesthesiology
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A 9-year-old boy underwent biopsy of the tumor at the external auditory meatus under general anesthesia with a laryngeal mask airway(LMA). During emergence from anesthesia, laryngospasm with marked inspiratory effort and cyanosis occurred. The LMA was removed and the patient was orotracheally intubated following vecuronium administration. ⋯ We suspected negative pressure pulmonary edema and treated him with mechanical ventilation with positive end-expiratory pressure. Seventeen hours later the pink frothy sputum decreased and he was extubated. Laryngospasm during emergence from anesthesia with an LMA can induce negative pressure pulmonary edema, especially in pediatric patients.
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We report that Trachlight-guided nasotracheal intubation might be achieved successfully and traumatically without removal of a stiff internal stylet. Endotracheal tube was mounted on a Trachlight with the stylet in position and bent to form a less sharp curvature than a right angle, namely 40-60 degree, at 7 cm proximal to the endotracheal tube tip. ⋯ The tracheas were successfully intubated in 89% of patients. We suggest that Trachlight-guided nasotracheal intubation could be clinically feasible without traumatic complication when applied with a stiff stylet in position and this approach is a useful method for nasal intubation.
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A 47-year-old female was scheduled for ulnar osteotomy under general anesthesia combined with brachial plexus block. She had a history of symptomatic epilepsy due to subarachnoid hemorrhage. Immediately after giving 100 mg bolus of propofol to the patient, she developed generalized convulsion similar to a grand mal. ⋯ After that no further convulsive attack occurred. Although it has been known that propofol has anticonvulsive properties, there have been several reported cases of seizure following the administration of propofol. Further studies are needed to clarify the mechanism of seizure induced by propofol in the patients with epilepsy.
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Case Reports
[Efficiency of bispectral index in anesthetic management of a patient with hypothyroidism].
A 72-year-old, female patient with severe hypothyroidism underwent tracheostomy using deltopectral flap. During the anesthetic management, we assessed the hypnotic level using the bispectral index and regulated the dose of general anesthetics to maintain the bispectral index at about 50. ⋯ Although the anesthetic requirement for patients with hypothyroidism is generally thought to be decreased, there is no practical index by which we can estimate the optimal dose of anesthetic agents for these patients. This case report shows that the assessment of the hypnotic level by the bispectral index can be utilized as an efficient index to determine the optimal dose of general anesthetics for patients with hypothyroidism.
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Finding appropriate endotracheal tube position in children is important, because the trachea length of a child is shorter than that of an adult, and the position of the endotracheal tube is easy to be altered by head position, rotary movements, and flexion as well as extension. We confirmed the correct depth of the endotracheal tube by transillumination method using the Trachlight device in children. Twenty children were intubated orally with a rigid laryngoscope according to the distance of the formula height/10 + 5 cm at the lips. ⋯ The distance between the carina and the tube tip measured by chest radiography was more than 1 cm. Trachlight device was simple and reliable to ensure the appropriate endotracheal tube position in children. We consider that the appropriate depth of the endotracheal tube using any of 4.5, 5.0 or 5.5 mm tube size is 1.5 cm beyond the point the bright light of the Trachlight disappears.