RESUMEN
We present a case of an 18-year-old male who underwent strabismus operation under general anesthesia. In his childhood, tracheostomy had been performed for the repair of cleft lip and palate. His Mallampati classification was IV and preoperative endoscopic examination revealed megaloglossia and severe airway narrowing. For possible difficult airway, intubating laryngeal airway (air-Q®, size 2.5) was used for tracheal intubation. Following insertion of air-Q®, trachea was intubated via air-Q® guided with fiberscope. The patient was ventilated via tracheal tube with the air-Q® remaining in place during the operation. air-Q® can be effectively utilized for airway management for an adult Apert syndrome patient
Asunto(s)
Acrocefalosindactilia/cirugía , Anestesia General , Intubación Intratraqueal/instrumentación , Adolescente , Broncoscopios , Humanos , Intubación Intratraqueal/métodos , Máscaras Laríngeas , Masculino , Estrabismo/cirugíaRESUMEN
We report a case of awake intubation in a patient with a difficult airway combined with severe hemorrhagic shock using the Pentax-AWS Airwayscope (AWS). A 65-year-old man experienced severe hemorrhagic shock due to diaphragmatic hernia after extrapleural pneumonectomy and was scheduled for emergent exploratory thoracotomy under general anesthesia. Blood pressure was maintained with dopamine-noradrenaline support, and rapid transfusion. We anticipated difficult ventilation due to a swollen face and tongue. The patient underwent awake intubation with the AWS under dexmedetomidine sedation and lidocaine spray for laryngotracheal anesthesia. The patient did not buck during intubation and hemodynamic changes were minimal.
Asunto(s)
Intubación Intratraqueal/métodos , Choque Hemorrágico/complicaciones , Anciano , Urgencias Médicas , Humanos , Intubación Intratraqueal/instrumentación , Laringoscopios , MasculinoRESUMEN
The intubating laryngeal airway, air-Q ILA, was recently introduced in Japan. It has been used in adult patients for difficult airway management; however, there are few reports available on its use in pediatric patients. We report the use of the air-Q ILA in predicted difficult airway management in a 16-month-old patient with Apert syndrome characterized by acrocephalosyndactyly undergoing a syndactyly operation. It was somewhat difficult to keep his airway with a facemask, and an air-Q ILA was inserted. Following the ventilation via air-Q ILA, tracheal intubation guided by a tracheal fiberscope was attempted through the air-Q ILA. Five months after this operation, the patient again underwent the same operation. We managed his airway in the same way as previously, and the tracheal was intubated. This case shows that the air-Q ILA can be an alternative device in pediatric difficult airway management.
Asunto(s)
Acrocefalosindactilia/cirugía , Manejo de la Vía Aérea/instrumentación , Intubación Intratraqueal/instrumentación , Polidactilia/cirugía , Adulto , Manejo de la Vía Aérea/métodos , Predicción , Humanos , Lactante , Intubación Intratraqueal/métodos , Máscaras Laríngeas , MasculinoRESUMEN
Perioperative fluid management for cases with severely compromised cardiac function undergoing major non-cardiac surgery remains a challenge. Dynamic parameters such as stroke volume variation (SVV) and cardiac index obtained by arterial pulse contour analysis may not be sufficient for fluid optimization because individualized optimal parameter values are difficult to determine in cardiac patients. We report two cases of abdominal surgery with severe pre-existing impairment of cardiac function (ejection fraction < 30%) complicated by severe pulmonary and renal dysfunction. In Case 1, because of unreliably high SVV values due to a sudden onset of cardiac arrhythmia, we performed colloid bolus infusion targeting central venous oxygen saturation (ScvO2) above 80%. In Case 2, cardiac index and stroke volume index remained unchanged despite the decrease of SVV after colloid bolus infusion. Infusion of dobutamine was useful for maintaining the ScvO2 above 75% in a rather hypovolemic state (SVV of 10-15%). Our cases suggest that the use of central venous oxygen saturation together with arterial pulse contour analysis may aid decision-making for individualized fluid optimization and use of inotropics in severely compromised cardiac patients undergoing major abdominal surgery.