Masui. The Japanese journal of anesthesiology
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A catheter was inserted through the cricothyroid membrane under general anesthesia using a laryngeal mask airway in two patients with pulmonary fungus ball of aspergillosis to administer an antimycotic into the fungus ball. Anesthesia was induced with fentanyl and propofol in both patients. The laryngeal mask airway was inserted using intravenous injection of vecuronium. ⋯ The catheter was inserted through the cricothyroid membrane and placed in the pulmonary fungus ball using bronchoscope. Perioperative and postoperative courses were uneventful in both patients. It was concluded that the laryngeal mask airway is useful for airway management when a catheter is inserted into a pulmonary fungus ball through the cricothyroid membrane.
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Patil-Syracuse mask, recently introduced in Japan, has a port for fiberscopy. A fiberoptic bronchoscope and an endotracheal tube can be passed through the port with little air leakage. ⋯ With a modified endoscopy mask technique, the mean expiratory tidal volume of 10 ml.kg-1 could be obtained during fiberoptic orotracheal intubation. We describe a fiberoptic intubation technique using this mask, and discuss the complications and limitations of this method.
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Apneic anesthesia with intermittent ventilation (AAIV) under inhalational anesthesia has been reported to improve visualization of the larynx with lack of vocal cord motion in laryngeal microsurgery. In this study, we evaluated AAIV using total intravenous anesthesia with propofol and fentanyl instead of inhalational anesthesia in 11 patients undergoing microsurgery of the larynx, and examined the effects of AAIV on respiration and circulation. Anesthesia was maintained with infusion of propofol 4-10 mg.kg-1.h-1 and intermittent administration of fentanyl and vecuronium intravenously. ⋯ End-tidal carbon dioxide level increased for 14.9 mmHg immediately after apneic periods. Propofol vielded stable and adequate levels of anesthesia during apneic periods. We conclude that AAIV using constant monitoring of Spo2 is a useful and safe technique, and that propofol is a suitable anesthetic agent for AAIV.
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Randomized Controlled Trial Clinical Trial
[Postoperative hoarseness and sore throat after tracheal intubation: effect of a low intracuff pressure of endotracheal tube and the usefulness of cuff pressure indicator].
Many clinical reports have described postoperative hoarseness and sore throat after general anesthesia. In most cases, these symptoms were attributed to high pressure of the endotracheal tube cuff. The recommended cuff pressure is less than 25 mmHg, as excessive pressure produces ischemia of the tracheal mucosa. ⋯ We investigated the incidence of postoperative hoarseness and sore throat at 24 hours after intubation and on the seventh postoperative day. The incidence of postoperative hoarseness and sore throat was significantly decreased in the low pressure group at 24 hours after intubation as compared with the high pressure group, but there was no significant difference between the two groups on the seventh postoperative day. These results suggest that keeping the cuff pressure under 15 mmHg can prevent postoperative hoarseness or sore throat at 24 hours after intubation, and that a cuff pressure gauge is thought to be one of the indispensable monitors during anesthesia.
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Randomized Controlled Trial Clinical Trial
[The effect of olprinone administered after cardio-pulmonary bypass during open heart surgery, evaluated by its plasma concentrations and hemodynamic changes].
Plasma concentrations and hemodynamic effects of olprinone were evaluated in seventeen patients undergoing open heart surgery. The patients were randomized into the bolus group (15 micrograms.kg-1 bolus dose +0.1 microgram.kg-1.min-1 infusion, n = 9) and the non-bolus group (0.1 microgram.kg-1.min-1 infusion, n = 8). ⋯ In the bolus group, increases in the cardiac index and stroke volume index were significantly higher compared with the non-bolus group. From these results we conclude that olprinone given in bolus (15 micrograms.kg-1) followed by continuous infusion (0.1 microgram.kg-1.min-1) is efficacious and safe during weaning from CPB.