Masui. The Japanese journal of anesthesiology
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Macroglossia is the commonest symptom of Beckwith-Wiedemann syndrome (BWS) and sometimes requires surgical tongue reduction for cosmetic, feeding, drooling and speech problems. ⋯ Airway disorder was not alleviated by tongue reduction surgery or glossopexy.
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There are only a few reports on cesarean section in a patient with cervical fracture without spinal cord injury (SCI). Such patients have high risks for deterioration of SCI following general or regional anesthesia. Here, we present a patient with a fracture of C2 vertebra who underwent cesarean section safely under combined spinal and epidural anesthesia(CSEA). ⋯ Pre-viability amniorrhexis was seen at 37 weeks' gestation, and an emergency cesarean section was scheduled under combined epidural and spinal anesthesia (CSEA). Her neck and head were carefully fixed before, during and after surgery in order to prevent subsequent SCI. As a result, cesarean section under CSEA was successfully performed in the patient without any deterioration of the spine and/or SCI.
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Several previous reports have established the Pentax Airway Scope (Pentax AWS, S-100, HOYA-PENTAX, Tokyo, Japan) as an efficient tool for endotracheal intubation in adult patients. To date, however, there are no reports on its use with the INTLOCK blade for neonatal and pediatric patients. In this case, we performed tracheal intubation using a Pentax AWS attached to a neonatal-type INTLOCK blade (ITL-N) twice, 1 day and 10 days after birth, in a neonatal patient complicated with Arnold-Chiari malformation. ⋯ We initially attempted tracheal intubation using a Miller's laryngoscope in the first operation and a Macintosh laryngoscope in the second, but we could not achieve tracheal intubation with either of these instruments. Upon switching to a Pentax AWS with an ITL-N, however, we successfully achieved tracheal intubation in both operations. Further research is needed to facilitate the effective use of the Pentax AWS in such cases.
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It has been demonstrated that preparatory ultrasound scanning can facilitate lumbar epidural anesthesia. We compared longitudinal with transverse approach of ultrasound imaging to test the precision and the quality of acquired images in cesar ean delivery patients. ⋯ Both planes provided accurate information about the epidural space and depth, and the longitudinal plane was superior in the imaging quality. It was suggested that both approaches may help identify epidural spaces.
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A 64-year-old woman was scheduled for the removal of hepatic cystadenoarcinoma. The preoperative examination did not reveal any neurological disorders. Anesthesia was induced with midazolam (5 mg) and remifentanil (0.1.ag x kg-1 x min-1) and the trachea was intubated following administration of rocuronium. ⋯ Two min later, she became fully awake and alert with increase in BIS (above 90). Laboratory examination showed that the plasma concentrations of propofol, midazolam, and its active metabolite alpha-hydroxymidazolam before administration of flumazenil were within the range considered to have no sedative effects. From experience of this case, administration of flumazenil may be beneficial for improvement in consciousness in cases with unexpectedly delayed emergence from anesthesia.