Masui. The Japanese journal of anesthesiology
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Case Reports
[Case of respiratory arrest during intraoperative magnetic resonance imaging (iMRI) for awake craniotomy].
We had a neurosurgical patient who developed apnea during iMRI. She was suspected of obstructive sleep apnea. The tumor had a risk of motor aphasia, and therefore awake craniotomy with iMRI was planned. ⋯ Awake craniotomy could be challenging because of unsecured airway with risks of vomitting, epileptic attacks or unstable level of consciousness. It is considered that the patient monitoring becomes more difficult when iMRI is performed because the patient's face cannot be obsereved directly. We should remember that conscious level as well as respiration pattern may change during operation.
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The i-gel is a rescue device for ventilation or tracheal intubation in patients with a difficult airway. The aim of this study was to evaluate the safety and reliability of fiberoptic-guided intubation through the i-gel in anesthetized patients with no history of difficult intubation undergoing elective surgery. ⋯ Fiberoptic-guided intubation could be performed safely through the i-gel. The i-gel is considered to be potentially useful as an alternative conduit for fiberoptic-guided intubation.
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We report a case of successful procedural sedation using dexmedetomidine (DEX) in a 68-year-old woman undergoing left gasserian ganglion block for intractable trigeminal neuralgia. DEX was chosen to provide an effective sedation and clear communication about the injection of drugs or thermocoagulation. After 15 minutes of DEX administration at 0.8 microg x kg(-1) x hr(-1), nerve block needle insertion was bearable. ⋯ High-frequency thermocoagulation elicited tolerable radiating pain with minimum vital sign change. She was comfortable and had no communication difficulty under DEX sedation. DEX sedation for interventional pain management during procedures such as gasserian ganglion block may be useful.
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We conducted a retrospective analysis of the intraoperative lactate level and its association with patients' outcome in adult cardiac surgery patients requiring cardiopulmonary bypass. ⋯ Increased lactate concentrations after weaning from CPB were significantly and independently associated with ICU free survival days at POD 28. This finding may be important to physicians in managing patients undergoing cardiac surgery using CPB.
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Comparative Study
[Endotracheal intubation in an adult patient fitted with a Leksell frame using a Pentax Airwayscope with a pediatric-type INTLOCK blade (ITL-P)].
Several previous reports have established the Pentax Airwayscope (Pentax AWS, S-100, HOYA-PENTAX, Tokyo, Japan) as an efficient tool for tracheal intubation in adult patients. The Pentax AWS is often successfully used with an INTLOCK blade; to date, however, INTLOCK blades have been released for neonatal and pediatric patients only. In this case, we performed tracheal intubation using a Pentax AWS attached to a pediatric-type INTLOCK blade (ITL-P) in an adult patient fitted with a Leksell Stereotactic frame (Elekta, Sweden). ⋯ Upon switching to a Pentax AWS with an ITL-P, we successfully achieved tracheal intubation without any complications. Anesthesia was maintained uneventfully with 3.0 microg x ml(-1) propofol and remifentanil 0.10 to 0.25 microg x kg(-1) x hr(-1) in oxygen and air. Further study is needed to facilitate the effective use of the Pentax AWS and the ITL-P in such cases.