Misplacement of left ventricular vent into the aortic root during a re-do Bentall procedure: a case report.

BACKGROUND: The left ventricular (LV) vent is commonly inserted via the right superior pulmonary vein (RSPV) and directed toward the LV cavity through the mitral valve. We report a rare case in which the tip of the LV vent was misplaced into the aortic root across the aortic valve. CASE PRESENTATION: An 88-year-old man was scheduled to undergo the Bentall procedure. After initiation of cardiopulmonary bypass, the LV vent was inserted via the RSPV. Anterograde cardioplegia was administered via the aortic root cannula after the ascending aorta was cross-clamped. The electrocardiogram did not result in complete cardiac arrest, even after delivery of two-thirds of the planned dose. A transesophageal echocardiographic examination showed that the tip of the LV vent was misplaced into the aortic root across the aortic valve. CONCLUSIONS: It is important to confirm the tip position by transesophageal echocardiography to prevent severe complications associated with the LV vent.

McGRATH MAC video laryngoscope assistance during transesophageal echocardiography may reduce the risk of complications: a manikin study.

BACKGROUND: Although transesophageal echocardiography (TEE) is considered a relatively safe diagnostic monitoring method, blind probe insertion is associated with pharyngeal trauma. Through visual observation of the esophageal inlet with the McGRATH video laryngoscope, it may be possible to insert the TEE probe at an appropriate angle and prevent pharyngeal trauma. We conducted a manikin study to investigate whether the use of the McGRATH video laryngoscope for TEE probe insertion reduced the pressure on the posterior pharyngeal wall. METHODS: Twenty-seven junior (inexperienced group) and 10 senior (experienced group) anesthesiologists participated in this study. The TEE probe was inserted into an airway manikin in a blind fashion (blind group) or under visualization with the McGRATH (McGRATH group) video laryngoscope (three times each). A sealed bag filled with normal saline was placed on the back of the posterior pharyngeal wall of the manikin and connected to a patient monitoring system via a pressure transducer. We measured the internal bag pressure and approximated this value to the pressure on the posterior pharyngeal wall. RESULTS: The pressure on the posterior pharyngeal wall was significantly lower in the McGRATH group than in the blind group (p < 0.001) and was significantly reduced when the McGRATH was employed in both the inexperienced (p < 0.001) and experienced (p < 0.001) groups. CONCLUSIONS: These findings suggest that TEE probe insertion under the assistance of the McGRATH video laryngoscope can reduce the pressure on the posterior pharyngeal wall, regardless of the clinician's experience, and may inform clinical practice with the potential to reduce probe insertion-associated complication rates.

[Effective Use of Combination of Ultrasound-guided Femoral Nerve Block and Lateral Femoral Cutaneous Nerve Block for Harvesting Skin Grafts: Three Case Reports].

The pain of skin graft site after surgery is compara- tively severe. We present three cases of combined of ultrasound-guided femoral nerve block and lateral fem- oral cutaneous nerve block that was effective for har- vesting skin grafts. Case 1 : a 32-year-old man had a split-thickness skin grafting of lateral upper arm harvested from outside of the thigh under general anesthesia, brachial nerve block, femoral nerve block and lateral femoral cutane- ous nerve block. Case 2 : a 39-year-old man had split-thickness skin grafting of lower thigh harvested from outside of the thigh under general anesthesia, femoral nerve block and lateral femoral cutaneous nerve block. Case 3 : a 94-year-old man had split-thickness skin grafting of acrotarsium harvested from outside of the thigh under spinal anesthesia, femoral nerve block, lat- eral femoral cutaneous nerve block and sciatic nerve block. In all cases, there was no pain just after surgery, and postoperative pain was controlled well through the hospitalization with administration of oral analgesic agents.

[A Case of Penetrating Injury of the Neck in Which It Was Difficult to Secure the Airway].

A 76-year-old man sustained a penetrating neck injury caused by a metal rake following an accidental fall. On admission, he showed clear consciousness and no dyspnea. CT revealed that the tips of three prongs of the rake were located close to the vertebral artery and trachea. Cerebral angiography identified an injury to the vertebral artery, but no injury to the trachea or oropharynx. He was scheduled for vertebral artery embolization under general anesthesia. Since the neck must be stabilized, we chose to perform rapid sequence induction of general anesthesia with endotracheal intubation using a fiberoptic bronchoscope. Fiber-optic intubation was more difficult than had been expected, and the SpO2 decreased; therefore, mask ventilation was performed using only the jaw-thrust maneuver without neck extension. Although we attempted fiberoptic intubation 5 times, we were unable to obtain a view of the airway for tracheal intubation. We considered tracheostomy, but, finally, 35 min after anesthesia induction, we succeeded in endotracheal intubation using Airwayscope® without neck movement. The glottis was noted to have deviated from the midline. No severe hypoxemia occurred during the clinical course. Various airway management devices have been developed, and we should consider switching quickly to alternative methods.