Introduction of laryngeal mask airway in Japan, and its rescue use for newborns.

BACKGROUND: In neonatal resuscitation, laryngeal mask airway (LMA) is recommended when both face mask ventilation and endotracheal intubation fail. Experience of LMA among obstetricians, nurses and midwives in Japan, however, is limited. The aims of the present study were to (i) offer an LMA training course to professionals dealing with low-risk pregnancies at institutions across Japan; and (ii) assess the subsequent use and value of LMA at the participating institutions. METHODS: Between August 2016 and March 2017, a total of 18 training courses for 60 min were provided for around 350 medical personnel from 51 institutes. LMA use over the subsequent 12 months was assessed via a postal questionnaire. RESULTS: After training, a total of 38 institutes introduced LMA. Of 13 254 live births, seven cases of rescue use LMA in "cannot ventilate, cannot intubate" situations were reported. None of these seven newborns had any malformation of the upper airway. LMA insertion resulted in adequate ventilation in all seven cases. CONCLUSION: LMA can be a life-saving tool in neonatal resuscitation. All medical institutions dealing with low-risk pregnancies in Japan should be equipped with this device.

Successful one-lung ventilation in a patient with the Fontan circulation undergoing thoracotomy: a case report.

The incidence of noncardiac surgery in patients with the Fontan circulation has increased over the years due to the elongated life expectancy of these patients. In patients with the Fontan circulation, pulmonary blood flow is passive, so it is important to keep pulmonary vascular resistance low. One-lung ventilation (OLV) can have adverse effects on the Fontan circulation due to hypoxia, hypoxic pulmonary vasoconstriction, hypercarbia, and increased airway pressure. We present a case of successful OLV in a patient with the Fontan circulation and describe our perioperative management.