RESUMO
We describe the clinical use of a new video-laryngoscope (McGRATH MAC, McG) in patients with a difficult airway and morbid obesity. In a patient, case no. 2, with a difficult airway, showing a Cormack-Lehane grade III view with Macintosh direct laryngoscope, the glottis opening (Cormack-Lehane grade I) was visualized with McG. McG also provided a good view of glottis opening in a patient with morbid obesity. McG will have a profound impact on the management of the difficult airway.
Assuntos
Intubação Intratraqueal/instrumentação , Laringoscópios , Idoso , Humanos , Masculino , Obesidade Mórbida/complicações , Cirurgia Vídeoassistida/instrumentaçãoRESUMO
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.
Assuntos
Anestesia Geral/instrumentação , Intubação Intratraqueal/instrumentação , Laringoscópios , Adolescente , Adulto , Idoso , Emergências , Feminino , Humanos , Intubação Intratraqueal/métodos , Masculino , Pessoa de Meia-IdadeRESUMO
We monitored sublingual tissue PCO2 (PSLCO2) continuously with an ISFET (ion-sensitive field effect transistor) based PCO2 sensor during and after surgical treatment for descending aortic aneurysm. Using femoro-femoral bypass and a beating heart technique, distal end of aneurysm was clamped and then selective cerebral perfusion was performed into the left subclavian and left common carotid arteries. Aneurysmectomy and reconstructive surgery were carried out with proximal end of the left common carotid artery being clamped. Upon starting selective cerebral perfusion, PSLCO2 increased abnormally. PSLCO2 increased from 38 mmHg just after induction of anesthesia to the maximum value of 87 mmHg during selective cerebral perfusion. Three hours after arriving in the intensive care unit, the patient developed convulsion and anisocoria and the computed tomography showed cerebral infraction. Since the blood flow to the tongue is fed through the internal and external carotid arteries, the increase in PSLCO2 is supposed to be caused by the decrease of blood flow to the tongue during selective cerebral perfusion. The monitoring of PSLCO2 may be a useful method to estimate the brain blood flow during selective cerebral perfusion.
Assuntos
Dióxido de Carbono/análise , Ponte Cardiopulmonar/métodos , Infarto Cerebral/diagnóstico , Monitorização Intraoperatória , Complicações Pós-Operatórias/diagnóstico , Glândula Sublingual/metabolismo , Idoso , Aneurisma da Aorta Torácica/cirurgia , Biomarcadores/análise , Circulação Cerebrovascular , Humanos , Masculino , Monitorização Intraoperatória/instrumentação , Pressão Parcial , Perfusão , Tomografia Computadorizada por Raios X , Procedimentos Cirúrgicos VascularesRESUMO
Non-cardiac surgery presents significant risks to patients with cardiac dysfunction. The relative safety of different anesthetic techniques has been studied without mentioning any clear indication. The depression of myocardial contractility by anesthetic agents limits their use in patients with cardiac dysfunction, especially for induction of anesthesia. We used olprinone hydrochloride perioperatively in the anesthetic management of three patients. In all cases, anesthetic induction, intraoperative course and the postoperative period proceeded uneventfully. We consider that perioperative use of continuous olprinone hydrochloride infusion may be suitable for patients with cardiac dysfunction for non-cardiac surgery.
