[Video-laryngoscope (McGRATH MAC): a clinical assessment of its performance in consecutive 100 patients].

BACKGROUND: The McGRATH MAC Video laryngoscope (Covidien Japan) is a relatively new device for tracheal intubation, which provides an excellent glottis view. We here report the clinical experience of the McGRATH in 100 patients who received general anesthesia. METHODS: Tracheal intubation with the McGRATH was performed in 100 patients requiring oro/naso tracheal intubation. The view of glottic opening was scored according to the classification of Cormack-Lehane. The time required to intubate and the number of intubation attempts were recorded. RESULTS: Cormack-Lehane classification 1 or 2 was obtained in 99 of 100 patients, respectively, and successful intubation was achieved in all patients. The mean +/- SD time to successful intubation was 40 +/- 19 seconds. CONCLUSIONS: The McGRATH was easily handled not only by experienced anesthetists but also by novice personnel. The McGRATH seems to be a useful device in routine and difficult airway management.

[Comparison of airway scope and videolaryngoscope portable VLP-100 in the presence of a neck collar--a manikin study].

BACKGROUND: Tracheal intubation should be performed with great care in the multiple injury patient, particularly when damage to the cervical spine is suspected. The patient with unstable cervical spine requires a neck collar in prehospital area, and medical personnel may be required to perform tracheal intubation. We compared Macintosh laryngoscope with the Airway Scope (AWS), and Coopdeck videolaryngoscope portable VLP-100 (VLP-100) in a manikin model with the presence of a neck collar. METHODS: We conducted a prospective study in 20 medical residents with little prior airway management experience. They inserted the AWS, VLP-100 and Macintosh laryngoscope, in turn, and the view of the glottis at laryngoscopy was graded, using a classification reported by Cormack and Lehane. Tracheal intubation time and the success rate of tracheal intubation (within 120 sec) were also recorded. RESULTS: The AWS provided a best view of the glottis, a shorter tracheal intubation time and a higher success rate of tracheal intubation, compared with VLP- 100 and Macintosh laryngoscope. CONCLUSIONS: The AWS may possess advantages over conventional direct laryngoscopes in patients with restricted neck movement.

[A case of craniofacial injury by javelin].

We report a case of 16-year-old woman with craniofacial impalement injury by javelin (used by athletic sports) thrown from a distance of 30 meters. When the patient was admitted to the emergency department, the javelin had been in the orbita, and the patient was assessed by trauma team including an anesthesiologist. The patient was alert and complained of severe pain. Head CT and X-ray indicated the javelin had entered though the orbita into the maxillary sinus. Sphenoidal sinus was also partly destroyed by the impact. Anesthesia was soon induced in the emergency room to release the patient from the unbearable pain. To avoid tension cephalus, awake fiberscopic endtracheal intubation was performed. Anesthesia was maintained with propofol, vecuronium and fentanyl before transporting the patient to an operating room. The javelin and her head were strongly fixed with fiber cast to prevent from moving while she was transported to the operating room. The javelin was successfully removed during the operation. The fractures were fixed, and lacerations were sutured. The most important principle of management with craniofacial impalement injury is that the impaling object should remain in situ while patient is rapidly transported to an operating room, since it could extend tissue injury, and have a tamponade-like effect on damaged vascular structure.

[Anesthetic management of 7-9th total spondylectomy for severe scoliosis].

Patients with scoliosis are at a great risk of perioperative problems including excessive blood loss, respiratory and circulatory failure, postoperative pain, malignant hyperthirmia and particularly, spinal cord damage. A case of a 22-year-old girl undergoing 7-9th total spondylectomy for severe scoliosis is presented. To avoid spinal cord damage, we employed deep anesthesia, wake-up test with BIS and postoperative pain management. After the surgery, the patient was transferred to ICU under deep anesthesia and controlled ventilation. The patient had no postoperative motor or sensory deficit, but further experience is needed.

[A case of coronary artery spasm during epidural anesthesia with continuous infusion of propofol].

A 50-year-old male patient was scheduled for left partial pulmonary resection and biopsy. The patient had neither complication nor history of ischemic heart disease. After arriving in the operation room, an epidural catheter was inserted into the epidural space at the T 4-5 intervertebral space. Anesthesia was induced with intravenous propofol 100 mg, fentanyl 100 microgram and vecuronium 6 mg and then a double lumen endotracheal tube was inserted. Anesthesia was maintained with O2 and air (FIO2 0.3-1.0), continuous infusion of propofol, intermittent intravenous administration of fentanyl and epidural injection of 1% lidocaine. Forty-five minutes after the start of operation, ECG showed an elevation of ST segment and soon it passed into ventricular tachycardia and ventricular fibrillation. The patient was treated with cardiopulmonary resuscitation. Fifteen minutes later, ECG returned to sinus rhythm but the elevation of ST segment remained. We considered that these cardiac events were due to coronary spasm, and started continuous infusion of nitroglycerin and nicorandil. One hour later, ST segment returned to normal. The possible inducing factors in this case were altered balance between sympathetic and parasympathetic nervous activity caused by infusion of propofol and epidural block, and alpha-stimulation caused by ephedrine.