Hypercapnic coma at the postanesthesia care unit: A case report / 대한마취과학회지

A 59-year-old woman underwent explorative laparotomy under general anesthesia for mechanical ileus. The patient had rectal cancer with multiple metastasis, and was receiving 1.5-2 mg of intravenous morphine per hour due to severe abdominal pain. After about 3 hours of general anesthesia, the patient was extubated and transferred to postanesthesia care unit. The patient was supplied with 6 L/min of oxygen by facial mask. In 30 minutes, the patient showed no response to verbal order and pain stimulus with sluggish eye reflex, although pulse-oximeter showed 98-99%. After emergent intubation, arterial blood gas was sampled, and the result showed severe acidosis with hypercapnia. The patient was transferred to intensive care unit, and after 1 hour of mechanical ventilation the patient became conscious then fully recovered without further complication.

Comparison of airwayscope to direct laryngoscope and lightwand for cardiovascular response in patients with difficult airway / 대한마취과학회지

BACKGROUND: Airwayscope (AWS), which has been used successfully for difficult airway in general anesthesia, has been anticipated that hemodynamic response to tracheal intubation in the difficult airway may be attenuated. Also, there is a series of reports demonstrating the successful use of lightwand to open the difficult airway. Thus, we decided to conduct a survey to compare AWS to lightwand and to direct laryngoscopy of cardiovascular response to tracheal intubation. METHODS: Of 64 healthy patients without cardiovascular disease, 22, 21, 21 patients were randomly assigned to AWS group, lightwand group and direct laryngoscope group. After induction of general anesthesia, intubation was performed with manual in-line neck stabilization. During laryngoscopy, a modified Cormack-Lehane grade was assessed and time to intubation was measured. Systolic arterial pressure (SAP) and heart rate (HR) were recorded at the following timepoints: baseline, just before intubation, 1 min, 2 min, 3 min, 4 min and 5 min after intubation. RESULTS: There were no significant differences between the 3 groups in SAP, HR (P > 0.05). However modified Cormack-Lehane grade of all patients in the AWS group was I, while that in direct laryngoscope group was IIB or III. In addition, the mean time to intubation of the direct laryngoscope group was significantly longer than that of the AWS and lightwand (P < 0.05). CONCLUSIONS: In the difficult airway, AWS was very effective in improving laryngeal view and decreasing time to intubation compared to direct laryngoscopey. In addition, lightwand reduced the time to intubation. However we could not find any significant difference in hemodynamic response to tracheal intubation among the 3 groups.

Emergency Airway Management using a Laryngeal Mask Airway (LMA) Following Extubation in an Infant with a Congenital Facial Anomaly: A case report / 대한마취과학회지

A female infant (4 months-old) with Goldenhar syndrome was scheduled for cheiloplasty to treat a transverse facial cleft and congenital macrostomia. There was no past history of difficulty during feeding or airway obstruction. Following induction of anesthesia using an inhalational anesthetic technique, conventional oro-tracheal intubation was possible. However, following extubation of the endotracheal tube she developed an upper airway obstruction. Her lungs could not be ventilated using a facial mask and oxygen saturation was decreased. A #1 laryngeal mask airway (LMA) was inserted immediately, which allowed us to ventilate her lungs and restore the oxygen saturation. Here we describe the use of a LMA for emergency airway management in an infant.