Masui. The Japanese journal of anesthesiology
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A 46-year-old man was diagnosed with descending colon cancer and was planned to undergo left hemicolectomy under general anesthesia. His body mass index was 42.6 and due to his small mouth and jaw, we anticipated difficult mask ventilation and tracheal intubation. ⋯ Then, we replaced the air-Q with an outside diameter 8.5 mm tracheal tube. This case was a successful use of the air-Q under moderate sedation for airway management in the setting of anticipated difficult mask ventilation and tracheal intubation.
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Case Reports
[A case of late drug-eluting stent thrombosis during postoperative period after 5 years of stent implantation].
Stent thrombosis during perioperative period is a critical complication for patients treated with drug-eluting stent (DES). We experienced a case of late DES thrombosis 5 years after initial implantation. A 48-year-old man with familial hyperlipidemia, angina pectoris and chronic pulmonary emphysema, was diagnosed with esophageal carcinoma, and scheduled for esophagectomy. ⋯ Emergent coronary angiography revealed re-stenosis of the right coronary artery treated with DES 5 years ago. At present, there was no definite guideline, on the management of DES during perioperative period. It is important for us to decide continuing antiplatelet therapy balancing the risk of stent thrombosis with surgical bleeding in each patient.
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We report a case of intraoperative kinking of an endotracheal tube (ETT) in a prone patient during spine surgery. We postulate that one of the risk factors involved with kinking was the inadequate withdrawal maneuver of Pentax-AWS Airway Scope (AWS). Patient was a 69-year-old woman with hypertension, diabetes mellitus, and rheumatoid arthritis, undergoing C4-6 laminoplasty under general anesthesia in the prone position. ⋯ The subsequent anesthetic course was uneventful. Kinking of the ETT in the oral cavity is an uncommon problem but we must keep in mind as one of the differential diagnoses. When using the AWS for endotracheal intubation, we recommend the confirmation of the position of the ETT to be normal in the oral cavity by direct laryngoscopy.
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The use of positive end-expiratory pressure (PEEP) is a practical intervention to improve oxygenation during anesthetic management; however, the underlying mechanisms have not been elucidated. ⋯ These results suggest that the mechanisms for improved oxygenation by PEEP under sevoflurane anesthesia are different from those under propofol anesthesia. The improved oxygenation after the application of PEEP under sevoflurane anesthesia is mainly due to reduction of atelectasis, whereas reduction of atelectasis as well as reduction of intrapulmonary shunt is associated with the improved oxygenation after the application of PEEP under propofol anesthesia.
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Comparative Study
[The KINGVISION: clinical assessment of performance in 50 patients].
The aim of this study was to evaluate the suitability of the KINGVISION videolaryngoscope for tracheal intubation. ⋯ The KINGVISION could be an effective aid to airway management in surgical patients.