[Use of the airway scope for rapid sequence induction in the emergency operation].

Rapid sequence intubation is a common procedure in emergency patients at risk for pulmonary gastric aspiration. However, in some of these cases may accompany a difficult airway. The Airway Scope (AWS) has been shown to be useful for difficult airway. We used AWS for rapid sequence intubation in 19 such patients. All patients were successfully intubated without any complication. We believe that AWS is a useful device for rapid sequence intubation.

[Use of the Airway Scope for awake intubation in five cases].

Several case reports have shown that the Airway Scope is useful in patients with difficult airways. We experienced five patients with known or predicted difficult airways who underwent awake intubation using the Airway Scope. The patients were known or predicted as having a difficult airway due to the following factors: limited head and neck movement (2 cases), risk for aspiration of gastric contents (1 case), and the thyroid tumor causing displacement of the trachea (2 cases). After the desired sedation with fentanyl and topical anesthesia of the airway, awake intubation was performed using the Airway Scope. All patients were successfully intubated without any complications. This experience suggests that the technique has the following advantages. First, the Airway Scope allows detection of regurgitation and vomiting during intubation and avoids accidental esophageal intubation. Second, the Airway Scope provides a useful means of teaching and supervising tracheal intubation compared with the conventional Macintosh laryngoscope. We believe that this method can achieve effective, safe and successful awake intubation in patients with known or predicted difficult airways.

[Case of undiagnosed vasospastic angina first noted during anesthesia].

A 75-year-old man patient was scheduled for total gastrectomy, splenectomy, and cholecyctectomy who had been hypertensive. The patient had no symptoms related to cardiac disease before surgery. Preoperative ECG showed only complete right bundle branch block. After arriving in the operating room, epidural anesthesia was performed at the T8-9 inter space and general anesthesia was induced with propofol without difficulty. Before operation, suddenly PVCs appeared, followed by VT and VF. Immediately the patient was treated with defibrillation, nitroglycerin and nicorandil. The operation was canceled. Vasospastic angina was diagnosed by acetylcholine infusion test postoperatively. Most of patients with vasospastic angina show elevation of ST segment on ECG at first, but our case showed VT and VF without ST elevation on ECG.

[Comparison of the Pentax-AWS and Fineview video laryngoscopes in the ease of laryngoscopy in 50 patients].

BACKGROUND: We compared the Pentax-AWS and Fineview video laryngoscopes in the ease of laryngoscopy in 50 patients. METHODS: Preoperatively, the view of the pharynx (Mallampati score), the thyromental distance and the inter-incisor distance at opening the month were assessed. After induction of anesthesia and neuromuscular blockade, the two devices were inserted in turn in a randomized order. The views of the glottis (Cormack and Lehane classification) was compared between the two devices. RESULTS: Mallampati score was 3 in one patient; the thyromental distance was less than 6 cm in 5 patients; and the inter-incisor distance was less than 4 cm in 2 patients. With the Pentax-AWS, the view of glottis was always grade 1, whereas with the Fineview, the view was grade 1 in 36 patients, grade 2 in 13 patients and grade 3 in one patient. The view was significantly better with the Pentax-AWS compared with the Fineview (P < 0.001). CONCLUSIONS: We conclude that the view of the glottis obtained using the Pentax-AWS was significantly better than the view obtained with the Fineview.

[Anesthetic management of coronary artery bypass grafting for unstable angina pectoris in a patient undergoing home oxygen therapy].

A 70-year-old man with pneumoconiosis receiving home oxygen therapy presented with chest pain. Coronary angiogram showed severe stenosis of his left main trunks and required emergency off-pump coronary artery bypass grafting. Anesthesia was induced and maintained with propofol, fentanyl and vecuronium. The trachea was intubated and the lungs were ventilated with oxygen and air maintaining the PaO2 between 80-100 mmHg and the PaCO2 between 55-65 mmHg. The operation was performed uneventfully. In the intensive care unit, the trachea was extubated after ensuring adequate respiratory function. The postoperative course was satisfactory.

[Anesthetic management for surgery of the ankle joint fracture in a patient with Ebstein's anomaly].

The authors describe the successful anesthetic management of a patient with Ebstein's anomaly and Wolff-Parkinson-White syndrome who underwent repair for foot joint fracture. Anesthesia was provided by combined spinal-epidural block to minimize hemodynamic changes which cause an increase in right-to-left shunt and hypoxemia. We estimated hemodynamic status using radial arterial pressure, central venous pressure and ECG from the start of anesthesia. During anesthesia, his vital signs were unchanged to any significant degree. The recovery was rapid and the postoperative course was uneventful.

[Use of a gum elastic bougie for tracheal intubation with Pentax-AWS airway scope].

Pentax-AWS laryngoscope (Pentax, Tokyo, Japan) consists of a disposable anatomically shaped blade, a 12-cm cable with a charge-coupled device (CCD) camera and a 2.4-inch liquid crystal device (LCD) color monitor display. A tracheal tube can be attached to the right side of the blade. The device may be useful in patients with difficult airways. One limitation of the device is that intubation may be difficult if it is difficult to position the glottis to the target symbol on the monitor display. We experienced such a difficulty in four patients, and the use of a gum elastic bougie enabled intubation. In a 57-year-old woman with a difficult airway, tracheal intubation using either a Macintosh laryngoscope or a fiberscope had failed. By inserting the AWS laryngoscope, the glottis was easily seen on the monitor display. Nevertheless, it was difficult to position the glottis to the target symbol, and advancing a tracheal tube collided with the tissue around the glottis. A bougie was passed through the tracheal tube, and it became possible to insert the bougie into the trachea by adjusting the angle of its tip. The tracheal tube was then easily passed over the bougie into the trachea. We successfully used the same technique in other three patients. We believe that the gum elastic bougie can be useful for tracheal intubation using the Pentax-AWS laryngoscope.

The Pentax-AWS video-laryngoscope: the first experience in one hundred patients.

We studied the efficacy of the Pentax-AWS (Tokyo, Japan), a new portable, battery-operated video-laryngoscope, in 100 patients. It was possible to insert the blade of the Pentax-AWS and to see a full view of the glottis on the first attempt in 99 of 100 patients. In the remaining patient, insertion of the Pentax-AWS was abandoned because of a risk of damaging teeth that were already loose. Tracheal intubation was successful in 98 patients. The median time taken for tracheal intubation was 35 s (range, 5-120 s).

[Pentax AWS airway scope].

Pentax AWS Airway Scope (Pentax, Japan) is a new videolaryngoscope. We successfully used the device in 15 patients and in other two patients with difficult airways. In a 51-year-old woman, after induction of anesthesia and neuromuscular blockade, laryngoscopy using a Macintosh blade showed only the tip of the epiglottis and tracheal intubation failed. Pressure on the neck and the use of gum elastic bougie did not solve the problem. When the Airway Scope was used, a full view of the glottis was obtained and the trachea was easily intubated. In a 71-year-old man, after induction of anesthesia and neuromuscular blockade, facemask ventilation was moderately difficult. At laryngoscopy using a Macintosh blade, the epiglottis was long and tubular, and tracheal intubation failed. With the Airway Scope, the trachea was intubated easily. We believe that the Pentax AWS videolaryngoscope is useful in patients with and without difficult airways.

[Effects of olprinone hydrochloride in patients undergoing off-pump coronary artery bypass grafting].

BACKGROUND: Olprinone hydrochloride (OLP) is a new phosphodiesterase III inhibitor with positive inotropic and vasodilator properties. It is characterized by strong inotropic effect and relatively weak vasodilating effect. Although the method for administration of OLP has been reasonably optimized, no studies have examined the administration mode for patients with off-pump coronary artery bypass grafting (OPCAB). METHODS: After the start of the operation, 12 patients received OLP 0.2 microg x kg(-1) x min(-1) (OLP group) and 14 patients received normal saline (control group). Catecholamines were concomitantly administered to maintain systolic pressure > or = 100 mmHg and cardiac index (CI) > or = 2.5 l x min(-1) x m(-2). Hemodymanic parameters were measured after induction of anesthesia, at the administration of heparin, immediately after coronary artery anastomosis, at the end of the operation, and 3 h and 6 h after the operation. RESULTS: Systolic and mean arterial pressures did not differ between the two groups. CI was significantly increased, and SVRI was significantly decreased after administration of heparin, immediately after coronary artery anastomosis, at the end of the operation and 3 h after the operation in the OLP group. OLP reduced the number of patients requiring dopamine and dobutamine compared with the control group. CONCLUSIONS: The study showed that OLP administrated during OPCAB may have improved hemodynamics in patients for OPCAB.