Successful Intubation Using the Airtraq Double Lumen® with the Universal Adapter for Smartphones® in a Case of Intubation Difficulty.

OBJECTIVE: The Universal Adapter for Smartphones® c an record s till images and movies during intubation using the monitor display and recording functions of a smartphone. Here, we describe the successful use of the Airtraq Double Lumen® with the Universal Adapter for Smartphones® for airway management during anesthesia in a patient with intubation difficulty. METHODS: A 78-year-old man required thoracoscopic upper lobectomy for a pulmonary tumor. Preoperative examination revealed micrognathia, mouth opening equivalent to a three-finger width, Mallampati Class II, mentum-hyoid bone distance equal to a 2.5-finger width, hyoid bone-thyroid cartilage distance equal to a two-finger width, and Class I findings in the Upper Lip Bite Test. After inducing anesthesia and confirming the feasibility of mask ventilation, we administered 70 mg of rocuronium and inserted the Airtraq Double Lumen®. The Universal Adapter for Smartphones® connected to a 4-inch iPod Touch® was attached to its eye cup, through which the iPod Touch displayed images for easy visualization of the glottal area. RESULTS: Prompt and smooth intubation with a 35-Fr double-lumen tube (DLT) was achieved. There were no adverse events associated with intubation. CONCLUSION: Combination of the Universal Adapter for Smartphones® and the Airtraq Double Lumen® can facilitate smooth tracheal intubation with a DLT in cases of difficult intubation.

Case of Wenckebach-type atrioventricular block caused by administration of indigo carmine.

We report a case of first-degree atrioventricular (A-V) block progressing to second-degree (Wenckebach-type) A-V block after administration of indigo carmine in a patient undergoing hysterectomy under general anesthesia. We believe that the onset of Wenckebach-type A-V block may have been induced by one or more of three factors: 1) preoperative first-degree A-V block, 2) the anesthetics used (propofol and remifentanil), and 3) administration of indigo carmine.

Applicability of a compact PT-INR measuring device CoaguChek XS to perioperative management.

OBJECTIVE: In perioperative management, prothrombin time (PT) expressed as the international normalized ratio (INR) is an important preoperative test to assess bleeding risk. It is also used to assess the effect of discontinuing anticoagulant therapy, to determine whether to treat patients with vitamin K or fresh frozen plasma, and to decide whether a deep nerve block (e.g., epidural anesthesia) is needed. Compared with other devices used to measure prothrombin time, the CoaguChek XS is a smaller, lighter and more convenient-to-use PT-INR monitoring system that requires a smaller venous, skin puncture or arterial blood sample than other systems. In a surgical setting, it is often more convenient to collect arterial blood. However, the applicability of arterial blood PT-INR values has not been verified. METHODS: We evaluated the usefulness of the CoaguChek XS in anesthetic management by comparing PT-INR values for arterial blood with those of venous blood in 50 patients who were scheduled for elective surgery under general anesthesia. RESULTS: Arterial PT-INR values were well correlated with venous PT-INR values (r2 = 0.9239; regression line y = 0.9537x + 0.0505). CONCLUSION: These results indicate that the CoaguChek XS system can provide arterial PT-INR values and should be available in operating and emergency rooms.