[McGRATH® MAC Is Useful to Learn Tracheal Intubation Using a Macintosh Laryngoscope].

BACKGROUND: Learning tracheal intubation using a Macintosh laryngoscope (McL) is important although video laryngoscope is becoming popular. The purpose of this study was to compare the usefulness as a training device for intubation technique using McL with three devices; McGRATH® MAC (MAC), Airwayscope® (AWS) and McL. METHODS: In this prospective study, 60 nurses not experienced in tracheal intubation were randomly assigned to MAC, AWS, and McL groups (each group: n=20), and 10 times of practice using each device were carried out. We compared the intubation time using McL and the nurse's anatomical understanding of the larynx before and after the practice. RESULTS: The intubation time before the practice was comparable among the three groups, but the time after the practice was significantly shorter in the McL and MAC groups compared to the AWS group (P=0.001). The practice significantly improved anatomical understanding of the larynx in all groups (P<0.05), and in particular it was improved in the MAC and AWS groups compared with the McL group (P<0.001). CONCLUSIONS: The McGRATH® MAC may possess advantages compared to Airwayscope® and Macintosh laryngoscope as a training device for learning intubation technique using Macintosh laryngoscope and understanding anatomy of the larynx.

[A patient with a huge posterior mediastinal tumor and ST-segment depression in electrocardiogram].

A 68-year-old woman had felt a chest and back pain for 3 months. Gradually her symptom became aggravated, and she felt severe dyspnea in supine position and dysphagia combined with superior vena cava syndrome. A huge posterior mediastinal tumor was revealed and her esophagus was severely narrowed on the chest MRI. Therefore, emergency tumor resection was scheduled under general anesthesia. Anesthesia was induced by midazolam (2 mg) with the patient in the right lateral position. After gas exchange and oxygenation were comfirmed by pulse oximetry reading and clinical signs, she was slowly turned to supine position. But, suddenly, ST-segment depression and low amplitude developed in electrocardiogram and systolic blood pressure was depressed to below 60 mmHg. Therefore, she was rapidly retuned to right lateral position, and ST-segment and systolic blood pressure recoverd. On the next time, although she was slowly turned to the right semi-lateral position, there was almost no circulatory failure. A bronchial tube was intubated in her left bronchia under bronchoscope. We should remember that the preparation of percutaneous cardiopulmonary support (PCPS) should be considered as a means of protection against cardiovascular collapse or airway obstruction perioperatively.

[Relationships between hemostatic variables and delay of surgical repair of femoral neck fracture in elderly patients].

BACKGROUND: This study was conducted to clarify the preoperative risk of thrombosis in elderly patients with femoral neck fracture by determining the relationships between hemostatic variables and time from injury until surgical repair. METHODS: Thirty-four patients over 70 years of age with femoral neck fracture were assigned to the following three groups according to the delay of surgical repair: usual operation group (within 3 days), delayed operation group (from 4 to 7 days) and much delayed operation group (more than 8 days). Hemostatic variables including molecular markers were determined before surgical repair. RESULTS: Thrombin antithrombin complex level in the usual operation group was significantly increased. The D-dimer level in the usual operation group was significantly higher than that in the delayed operation group, but the levels in the delayed and much delayed operation groups were still higher than the levels in normal subjects. CONCLUSIONS: These findings suggest that elderly patients with femoral neck fracture may have a relatively high risk for the occurrence of pulmonary thromboembolism receiving anesthesia for surgical repair because of hypercoagulopathy caused by stress response and possible deep vein thrombosis caused by lying on a bed for a long period.