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1.
Masui ; 65(10): 1073-1077, 2016 10.
Article in Japanese | MEDLINE | ID: mdl-30358292

ABSTRACT

BACKGROUND: We performed a questionnaire survey to investigate anesthesiologist attitudes toward para- medic tracheal intubation clinical training and related issues. METHODS: Twenty-four anesthesiologists (clinical expe- rience, 18.4?12.2 years) answered a questionnaire regarding their attitudes toward paramedic clinical training and complications encountered during training. Participants were also asked about the number of cases paramedics should be required to handle for tra- cheal intubation training. RESULTS: Over 75% and 80% of anesthesiologists responded that paramedics had difficulty performing mask ventilation and stomach expansion, respectively. Moreover, roughly 25% encountered tooth injury, and 75% lip injury. Over 90% agreed that simulation train- ing before clinical training is important. The respon- dents thought 37.5 ?25.0 cases should be required for Macintosh laryngoscope training, and 20.0?13.6 cases for videolaryngoscope training. CONCLUSIONS: Our results suggest the need for improvements in paramedic clinical training, including pre-training education about perioperative medicine and operating room rules.


Subject(s)
Intubation, Intratracheal , Allied Health Personnel , Anesthesiologists/education , Attitude , Humans , Intubation, Intratracheal/methods , Laryngoscopes
2.
Masui ; 63(7): 804-6, 2014 Jul.
Article in Japanese | MEDLINE | ID: mdl-25098142

ABSTRACT

We present a case of anticipated difficult airway with severe rheumatoid arthritis in which intubation with fiberoptic bronchoscope (FOB) assisted by Pentax-AWS Airwayscope with the thin Intlock (AWS T) was effective. A 69-year-old woman was scheduled to undergo laparoscopic cholecystectomy for acute cholecystitis in a previous hospital. Tracheal intubation with Glidescope or nasal intubation was unsuccessful and abandoned due to mucosal injury and bleeding. Ventilation via several supraglottic airway devices was unsatisfactory, while mask ventilation was easy after induction of anesthesia. She was referred to our hospital for application of veno-arterial extracorporeal life support in case of 'cannot ventilate and cannot intubate'. We planned to perform tracheal intubation preserving spontaneous breathing under intravenous administration of dexmedetomidine and fentanyl. We could visualize the epiglottis, but could not set the target mark to the invisible glottis with AWS-T. Finally, we could accomplish uneventful tracheal intubation with FOB along with the Intlock's guides of AWS-T.


Subject(s)
Arthritis, Rheumatoid/complications , Intubation, Intratracheal/instrumentation , Aged , Airway Management , Cholecystectomy, Laparoscopic , Female , Humans , Intubation, Intratracheal/methods
3.
J Anesth ; 28(3): 447-51, 2014 Jun.
Article in English | MEDLINE | ID: mdl-24141810

ABSTRACT

We report a case of diplopia during continuous epidural injection presumably caused by catheter migration. A 61-year-old woman underwent shoulder surgery under general anesthesia with cervical epidural anesthesia. The epidural catheter was placed in the C6-C7 epidural space with some difficulty before general anesthesia. The depth of the catheter placed under the skin was 10 cm. On POD 2, the patient noticed diplopia and developed dysarthria despite of good pain control so far. She complained of sudden headache after the rate of continuous epidural infusion was increased to relieve postoperative pain. Computed tomography and T2-weighted cerebral magnetic resonance imaging revealed an air image and surrounding edema in the pons. Diplopia and dysarthria disappeared after ceasing continuous epidural injection. A 15-cm-long mark under the skin and leak of colorless clear fluid from the puncture site were noted at removal of the catheter. On POD 13, diplopia recurred, which improved gradually. On the 9-month radiologic follow-up, we considered that the symptoms on POD 2 were caused by migration of the epidural catheter into the pons and that her later diplopia was induced by intracranial hypotension syndrome. One should be aware that such an unexpected migration of the catheter can occur following a difficult insertion.


Subject(s)
Anesthesia, Epidural/adverse effects , Catheterization/adverse effects , Diplopia/etiology , Intracranial Hypotension/etiology , Shoulder/surgery , Anesthesia, Epidural/methods , Brain Stem/anatomy & histology , Brain Stem/pathology , Catheterization/methods , Diplopia/pathology , Edema/etiology , Edema/pathology , Epidural Space/anatomy & histology , Female , Headache/etiology , Headache/pathology , Humans , Intracranial Hypotension/complications , Intracranial Hypotension/pathology , Middle Aged , Pain, Postoperative/therapy , Shoulder/pathology
4.
Masui ; 61(7): 765-8, 2012 Jul.
Article in Japanese | MEDLINE | ID: mdl-22860311

ABSTRACT

Kommerell's diverticulum is a rare anomaly of the aortic arch. A 59-year-old man was scheduled for open reduction and internal fixation of his right proximal tibial fracture under general anesthesia. We diagnosed right-sided aortic arch by the chest X-ray and thoracic computed tomography. His trachea and esophagus were compressed by the aortic arch. He had complained of no dyspnea or dysphagia. Respiratory difficulty might be caused by muscle relaxants, intermittent positive pressure ventilation, change of intrathoracic pressure, postural change and overloaded infusion during general anesthesia in a case of right-sided aortic arch. We performed lumbar epidural anesthesia and inserted an i-gel after general anesthesia induction preserving spontaneous respiration in preparation for controlled ventilation or tracheal intubation via an i-gel. We could accomplish the operation uneventfully and he was discharged on POD 53. A supraglottic airway such as an i-gel was a useful device in the present case of right-sided aortic arch with Kommerell's diverticulum.


Subject(s)
Anesthesia, General , Aorta, Thoracic/abnormalities , Aorta, Thoracic/diagnostic imaging , Diverticulum/diagnostic imaging , Preoperative Period , Airway Management/instrumentation , Fracture Fixation, Internal , Humans , Male , Middle Aged , Radiography , Tibial Fractures/surgery , Treatment Outcome
5.
Eur J Anaesthesiol ; 28(8): 597-9, 2011 Aug.
Article in English | MEDLINE | ID: mdl-21505345

ABSTRACT

CONTEXT AND OBJECTIVE: We hypothesised that head and neck position could affect the effectiveness of ventilation with the i-gel airway. To test this hypothesis, we investigated the influence of different head and neck positions on oropharyngeal sealing pressures and ventilation scores during ventilation with i-gel. METHODS: A single, experienced supraglottic airway device user inserted the i-gel in 20 paralysed, anaesthetised patients who were scheduled for oral surgery. Oropharyngeal leak pressures and ventilation scores were measured with the head and neck in the neutral position, flexed, extended or rotated to the right. Ventilation was scored from 0 to 3 based on three criteria (no leakage with an airway pressure of 15 cmH2O, bilateral chest excursion and a square wave capnogram; each item scoring 0 or 1 point). RESULTS: Compared with the neutral position (25.8 ± 5.2 cmH2O), oropharyngeal leak pressure was significantly higher with flexion (28.5 ± 3.4 cmH2O, P=0.015) and lower with extension (23.0 ± 4.2 cmH2O, P=0.015), but similar with rotation (26.7 ± 5.1 cmH2O, P=0.667). Flexion of the head and neck [2 (1-3)] adversely affected the ventilation score compared with the neutral position [3 (2-3), P=0.004]. CONCLUSION: Effective ventilation with an i-gel can be performed in patients in whom the head and neck is extended or rotated, whereas flexion of the head and neck adversely affects ventilation. Clinically, flexion of the head and neck should be avoided during ventilation with the i-gel.


Subject(s)
Airway Management/methods , Paralysis/complications , Posture , Respiration, Artificial/methods , Adolescent , Adult , Aged , Aged, 80 and over , Airway Management/instrumentation , Anesthesia, General/methods , Female , Head , Humans , Male , Middle Aged , Neck , Oral Surgical Procedures/methods , Oropharynx , Pressure , Respiration, Artificial/instrumentation , Young Adult
6.
J Oral Maxillofac Surg ; 69(5): 1311-5, 2011 May.
Article in English | MEDLINE | ID: mdl-21256645

ABSTRACT

PURPOSE: This study investigated the effects of head-neck extension on abnormalities of laryngeal mask airway (LMA) function resulting from opening the mouth. PATIENTS AND METHODS: A single, experienced LMA user inserted the LMA in 15 patients scheduled for elective oral surgery. Oropharyngeal leak pressure and intracuff pressure were sequentially documented in 5 mouth conditions in order (0 minutes, mouth closed plus 0° extension; 3 minutes, mouth open plus 0° extension; 6 minutes, mouth open plus 15° extension; 9 minutes, mouth open plus 30° extension; and 12 minutes, mouth open plus 45° extension). RESULTS: Oropharyngeal leak pressures with the mouth open plus 0° extension (30.7 ± 5.6 cm H(2)O, P < .001), mouth open plus 15° extension (29.1 ± 6.8 cm H(2)O, P < .001), and mouth open plus 30° extension (25.7 ± 6.1 cm H(2)O, P < .001) were significantly higher than with the mouth closed plus 0° extension (19.7 ± 2.8 cm H(2)O). Compared with the position with the mouth closed plus 0° extension (60.0 ± 0 cm H(2)O), intracuff pressures were also higher with the mouth open plus 0° extension (84.5 ± 14.1 cm H(2)O, P < .001), mouth open plus 15° extension (77.4 ± 11.0 cm H(2)O, P < .001), and mouth open plus 30° extension (73.6 ± 9.6 cm H(2)O, P < .001). Both measurement values returned to control levels when the position with the mouth open plus 45° extension was assumed (oropharyngeal leak pressure, 64.5 ± 6.5 cm H(2)O [P = .212]; intracuff pressure, 20.2 ± 4.9 cm H(2)O [P = .969]). CONCLUSIONS: In procedures requiring the patient to have an open mouth under general anesthesia using LMA, 45° head-neck extension achieves acceptable airway conditions.


Subject(s)
Airway Management , Head/anatomy & histology , Laryngeal Masks , Mouth/physiology , Neck/anatomy & histology , Adolescent , Adult , Aged , Aged, 80 and over , Capnography , Elective Surgical Procedures , Female , Humans , Male , Middle Aged , Oral Surgical Procedures , Oropharynx/physiology , Patient Positioning , Posture/physiology , Pressure , Respiration , Tidal Volume/physiology , Time Factors , Young Adult
7.
J Oral Maxillofac Surg ; 69(4): 1018-22, 2011 Apr.
Article in English | MEDLINE | ID: mdl-20727637

ABSTRACT

PURPOSE: This study was performed to determine the optimal degree of mouth opening in anesthetized patients requiring laryngeal mask airway (LMA) during oral surgery. PATIENTS AND METHODS: A single, experienced LMA user inserted the LMA in 15 patients who were scheduled for elective oral surgery. Oropharyngeal leak pressure, intracuff pressure, and fiberoptic assessment of the LMA position were sequentially documented in 5 mouth conditions-opening of 1.4 (neutral position), 2, 3, 4, and 5 cm-and any resulting ventilatory difficulties were recorded. RESULTS: Oropharyngeal leak pressure with the mouth open 4 cm (21.8 ± 3.2 cm H(2)O, P = .025) and 5 cm (27.3 ± 7.2 cm H(2)O, P < .001) was significantly higher than in the neutral position (18.1 ± 1.5 cm H(2)O), as was intracuff pressure (neutral position, 60.0 ± 0 cm H(2)O; 4 cm, 72.6 ± 5.1 cm H(2)O [P < .001]; and 5 cm, 86.9 ± 14.4 cm H(2)O [P < .001]). LMA position, observed by fiberoptic bronchoscopy, was unchanged by mouth opening, being similar in the 5 mouth conditions (P = .999). In addition, ventilation difficulties (abnormal capnograph curves or inadequate tidal volume) occurred in 2 of 15 patients (13%) and 7 of 15 patients (53%) (P < .001) with the mouth opening of 4 and 5 cm, respectively. CONCLUSIONS: This study showed that a mouth opening over 4 cm led to substantial increases in oropharyngeal leak pressure and intracuff pressure of the LMA, warranting caution, because gastric insufflation, sore throat, and ventilation difficulties may occur. A mouth opening of 3 cm achieves acceptable airway conditions for anesthetized patients requiring LMA.


Subject(s)
Airway Management , Laryngeal Masks , Mouth/physiology , Oral Surgical Procedures , Adolescent , Adult , Aged , Aged, 80 and over , Bronchoscopy , Capnography , Elective Surgical Procedures , Epiglottis/anatomy & histology , Female , Humans , Male , Middle Aged , Optical Fibers , Oropharynx/physiology , Pressure , Tidal Volume/physiology , Vocal Cords/anatomy & histology , Young Adult
8.
J Oral Maxillofac Surg ; 68(5): 1038-42, 2010 May.
Article in English | MEDLINE | ID: mdl-20223572

ABSTRACT

PURPOSE: The aim of this study was to investigate the influence of mouth opening on oropharyngeal leak pressure, intracuff pressure, and cuff position of the laryngeal mask airway (LMA). PATIENTS AND METHODS: Fifteen patients who were scheduled for elective oral surgery were recruited into this study. A single, experienced LMA user inserted the LMA according to the manufacturer's recommended technique. Oropharyngeal leak pressure, intracuff pressure, and fiberoptic assessment of the LMA position were documented under 3 mouth conditions: neutral position (1.4-cm distance between upper and lower incisors), mouth open (5- to 6-cm distance between upper and lower incisors), and return to the neutral position. Any ventilation difficulties under the 3 mouth conditions were recorded. RESULTS: Oropharyngeal leak pressure with the mouth open was higher than in the neutral position (P < .001). Compared with the neutral position, intracuff pressure was also higher with the mouth open (P < .001). Both measurement values returned to control levels when the neutral position was once again assumed. The LMA position observed by fiberoptic bronchoscopy was unchanged by mouth opening and was similar in the 3 mouth conditions (P = .998). Although ventilatory difficulties occurred after mouth opening in 8 of 15 patients (P < .001), it did not occur when the neutral position was reassumed. CONCLUSIONS: This study showed that mouth opening led to substantial increases in oropharyngeal leak pressure and intracuff pressure of the LMA, warranting caution because gastric insufflation, sore throat, and ventilation difficulties may occur.


Subject(s)
Laryngeal Masks , Mouth/physiology , Oropharynx/physiology , Adolescent , Adult , Aged , Aged, 80 and over , Bronchoscopes , Capnography , Elective Surgical Procedures , Epiglottis/anatomy & histology , Female , Humans , Incisor/anatomy & histology , Male , Mandible/anatomy & histology , Maxilla/anatomy & histology , Middle Aged , Optical Fibers , Oral Surgical Procedures , Posture , Pressure , Respiration , Tidal Volume/physiology , Vocal Cords/anatomy & histology , Young Adult
9.
Masui ; 58(4): 474-6, 2009 Apr.
Article in Japanese | MEDLINE | ID: mdl-19364014

ABSTRACT

A 59-year-old woman with an epiglottic tumor was scheduled for the total removal of the mass by laryngomicrosurgery. The patient had no preoperative respiratory symptoms. During the induction of anesthesia, the mask ventilation was easily accomplished; however, when rigid laryngoscopy was attempted, an epiglottic tumor prevented exposure of the vocal cords. After a size 3 Cobra PLA had been placed, a size 6.5 mm reinforced tube was threaded over a fiberoptic bronchoscope through the Cobra PLA into the trachea. Post-extubation course was uneventful. The Cobra PLA can be a good alternative supraglottic airway device allowing easy tracheal intubation for difficult airway.


Subject(s)
Epiglottis , Fiber Optic Technology/instrumentation , Intubation, Intratracheal/instrumentation , Laryngeal Neoplasms/surgery , Female , Fiber Optic Technology/methods , Humans , Intubation, Intratracheal/methods , Middle Aged , Treatment Outcome
10.
Masui ; 56(4): 446-9, 2007 Apr.
Article in Japanese | MEDLINE | ID: mdl-17441457

ABSTRACT

HIFU therapy is one of epoch-making, low-invasive treatments for prostate cancer. We investigated 71 patients who had undergone HIFU therapy from June 2004 through September 2005. We mainly gave a single spinal injection followed by epidural catheterization with a combined spinal-epidural anesthesia kit. Three patients received general anesthesia because of various problems such as allergy for local anesthetics, ankylosing spondylitis and severe spinal deformity causing difficulty in lumbar puncture. Spinal anesthesia was successfully achieved in most patients. Twelve patients with insufficient anesthetic levels required additional local anesthetics via epidural catheters. We found no serious perioperative complications.


Subject(s)
Anesthesia, Epidural , Anesthesia, Spinal , Prostatic Neoplasms/therapy , Ultrasound, High-Intensity Focused, Transrectal , Aged , Anesthesia, General , Humans , Male , Middle Aged , Treatment Outcome
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