Masui. The Japanese journal of anesthesiology
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Case Reports
[A case of pulmonary edema following upper airway obstruction after general anesthesia].
A 30-year-old man underwent tonsillectomy and laryngomicrosurgery under nitrous oxide oxygen-isoflurane anesthesia. Preoperative physical examinations and interview revealed no cardiopulmonary abnormalities. Two minutes after extubation, he showed dyspnea with marked inspiratory efforts and cyanosis due to laryngeal spasm. ⋯ He was discharged from the hospital on the 8th post-operative day. We reported a case of pulmonary edema after laryngeal spasm. It was suggested that a patient after acute upper airway obstruction should be carefully treated considering secondary pulmonary edema.
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Clinical Trial
[Cardiovascular responses during laryngeal mask airway insertion in normotensive, hypertensive and chronic renal failure patients].
The hemodynamic response to the insertion of the laryngeal mask airway (LM) following induction with propofol 2 mg.kg-1 was assessed and compared in normotensive (Normal), hypertensive (HT) and chronic renal failure (CRF) patients (n = 23 in each group). Before induction, in HT and CRF groups blood pressure and rate pressure products (RPP) were higher than in Normal group (P < 0.05). ⋯ There were no differences between groups in heart rate and rate of successful LM insertion. We concluded that LM insertion with propofol 2 mg.kg-1 was an effective induction method preventing the adverse circulatory responses in normotensive, hypertensive and chronic renal failure patients.
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We developed a new type of bite block with a combined function as an endotracheal tube (ETT) holder for infants and small children to prevent airway troubles caused by tube kinking, dislodging, extubation and oral membrane trauma. One mm thick plastic plate sized 3.5 x 2 cm was curved to make an open roll. The outer surface of the roll was covered and glued with soft plastic tube (5.0 mm ID endotracheal tube), cut in 3.5 cm length to give an elastic outer surface for the patient's comfort. ⋯ Our bite block has following advantages over other types of bite blocks and tube holders especially for children; 1) the volume of foreign bodies (ETT and bite block) occupying the oral cavity can be reduced and this attenuates the patient's discomfort, 2) good holding of the ETT can prevent its dislodging and decrease the incidence of accidental extubation and 3) suctioning is easier because of wide oral space. The four sizes of the bite block suitable for 4.0, 4.5, 5.0, 5.5 and 6.0 mm ID ETTs are manufactured. We applied this device to several ICU patients and found its use practical and safe.
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We examined the influence of the bolus injection rate of propofol on the cardiovascular depression and injection pain. Fifty-one patients of ASA grade 1 or 2 were randomly allocated to two groups. After premedication with midazolam 0.06 mg.kg-1 and atropine 0.006 mg.kg-1 i.m., propofol 2 mg.kg-1 was injected to a forearm vein at a rate of 800 ml.hr-1 in Group A or 1 ml.s-1 in Group B. ⋯ The induction time was significantly shorter in Group B than in Group A (40 vs. 73 sec: P < 0.01). There were no significant differences between the two injection rates in peak reductions in systolic and diastolic blood pressure and heart rate. In conclusion, rapid injection of propofol was effective to shorten the induction time without any adverse effects.
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Multicenter Study Clinical Trial
[A multicenter study for evaluating a new intubating laryngeal mask airway].
A multicenter study was performed to evaluate the success of endotracheal intubation using an intubating laryngeal mask (ILM, Fastrach) in patients in ASA status I or II, aged 20 years or more, who underwent general anesthesia. A total of 191 patients were studied, and 24 of them were estimated difficult to intubate by the ordinary method with laryngoscope. Endotracheal intubation was successfully performed through ILM in 162 of the 191 (success rate of 84.8%). ⋯ The success rate did not depend on the clinical experience of anesthesiologists, and the individual success rate was improved as they became more experienced. Of the 24 patients who had been estimated difficult to intubate with laryngoscope, 23 were successfully intubated with success rate of 95.8%. In summary, endotracheal intubation through ILM was easy regardless of the anesthesiologist's experience, and seemed to be valuable for patients who were difficult to intubate.