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Subglottic stenosis (SGS) can be asymptomatic in cases with slow-growing granulomas. In this study, we report a case of SGS discovered during tracheal intubation for anesthesia induction. A 74-year-old woman was scheduled for surgery under general anesthesia for a left humeral fracture. Resistance was observed when the tracheal tube passed through the glottis, stopping the tube from advancing. We placed a laryngeal mask (LMA) to secure her airway and examined it using a bronchial fiber to detect circumferential stenosis of the subglottis due to granulation. The airway was secured using an LMA instead of intubation, and the patient was successfully managed under anesthesia. Asymptomatic SGS is difficult to detect preoperatively, and anesthesiologists may encounter unexpected intubation issues. LMA is an important tool for an effective strategy to manage intubation difficulties.
RESUMO
BACKGROUND: There are no reports of anesthesia use in adult patients with Silver-Russell syndrome (SRS). Here, we report our experience with anesthesia in an adult patient with SRS complicated by chronic respiratory failure. CASE PRESENTATION: A 33-year-old woman was clinically diagnosed with SRS. She had severe chronic respiratory failure, complicated by superior mesenteric artery syndrome. Percutaneous gastrostomy was scheduled for nutritional management under epidural anesthesia; however, soon after esophagogastroduodenoscopy was started, she lost consciousness and spontaneous respiration. The patient was urgently intubated and converted to general anesthesia. The end-tidal carbon dioxide tension was > 90 mmHg at intubation. CONCLUSIONS: Adult SRS patients with chronic respiratory failure have a risk of CO2 narcosis. SRS also requires preparation for difficult airway management during the perioperative period.
RESUMO
BACKGROUND: Downfolding of the epiglottis into the laryngeal inlet is considered to be a rare complication of tracheal intubation. We describe a case of epiglottic downfolding during tracheal intubation using a McGrath videolaryngoscope (McGRATHTM MAC). CASE PRESENTATION: A 44-year-old female was scheduled for breast reconstruction surgery. Intubation was performed using a McGrath videolaryngoscope. After intubation, videolaryngoscopy revealed that the epiglottis was inverted and folded down into the laryngeal inlet. We elevated the larynx anteriorly using the McGrath videolaryngoscope, enabling the downfolded epiglottis to be pulled out from the laryngeal inlet and restored to its original position. After surgery, the patient was extubated without any complications. CONCLUSIONS: When using the McGrath videolaryngoscope, both glottic exposure similar to that achieved with the Macintosh laryngoscope and careful observation of the epiglottis should enable the prevention, detection, and treatment of epiglottic downfolding into the laryngeal inlet.
RESUMO
Bone mass is regulated by osteoblast-mediated bone formation and osteoclast-mediated bone resorption. We previously reported that harmine, a ß-carboline alkaloid, inhibits osteoclast differentiation and bone resorption in vitro and in vivo. In this study, we investigated the effects of harmine on osteoblast proliferation, differentiation and mineralization. Harmine promoted alkaline phosphatase (ALP) activity in MC3T3-E1 cells without affecting their proliferation. Harmine also increased the mRNA expressions of the osteoblast marker genes ALP and Osteocalcin. Furthermore, the mineralization of MC3T3-E1 cells was enhanced by treatment with harmine. Harmine also induced osteoblast differentiation in primary calvarial osteoblasts and mesenchymal stem cell line C3H10T1/2 cells. Structure-activity relationship studies using harmine-related ß-carboline alkaloids revealed that the C3-C4 double bond and 7-hydroxy or 7-methoxy group of harmine were important for its osteogenic activity. The bone morphogenetic protein (BMP) antagonist noggin and its receptor kinase inhibitors dorsomorphin and LDN-193189 attenuated harmine-promoted ALP activity. In addition, harmine increased the mRNA expressions of Bmp-2, Bmp-4, Bmp-6, Bmp-7 and its target gene Id1. Harmine also enhanced the mRNA expressions of Runx2 and Osterix, which are key transcription factors in osteoblast differentiation. Furthermore, BMP-responsive and Runx2-responsive reporters were activated by harmine treatment. Taken together, these results indicate that harmine enhances osteoblast differentiation probably by inducing the expressions of BMPs and activating BMP and Runx2 pathways. Our findings suggest that harmine has bone anabolic effects and may be useful for the treatment of bone-decreasing diseases and bone regeneration as a lead compound.