[Laryngeal Tube Position Shift after Chest Compression: Comparison of Fixation Methods Using Durapore Tape, Multipore Tape, or a Neck Tape].

BACKGROUND: The laryngeal tube (LT ; Smiths Medical, Minnesota, U. S. A) is an inflatable supraglottic device for emergency airway management such as during chest compression, the instability after insertion remains a problem. METHODS: We investigated the effectiveness of three fixation methods of LT using a manikin and automated chest compressor. RESULTS: After 10-minute chest compression, LT without fixation was shifted by 0.4 ± 0.1 cm, which was greater than with Durapore tape (0.2 ± 0.1 cm), Multipore tape (0.2 ± 0.1 cm), or a neck tape (0.1 ± 0.1 cm). The shift of the position was smaller with neck tape fixation compared to Durapore or Multipore tape fixation. CONCLUSIONS: A fixation neck tape may be useful in stabilizing the inserted position of LT during cardiopulmonary resuscitation.

[Development of Takotsubo Cardiomyopathy during Recovery from General Anesthesia: A Case Report].

Takotsubo cardiomyopathy is a cardiac syndrome characterized by transient left ventricular dysfunction. A 61-year-old woman underwent laparoscopic cholecystectomy under general anesthesia. During recovery from general anesthesia, several arrhythmias occurred without cardiac collapse following desflurane discontinuation and sugammadex sodium administration. She had a chest pain after extubation, with ST segment elevation in leads aV(L) and V2-4. Emergency left ventricular angiogram revealed no significant coronary stenosis, and excessive contraction of the base and severe hypokinesis of the apex suggested Takotsubo cardiomyopathy. Sympathetic hyperactivity during acute recovery from anesthesia with desflurane discontinuation and muscle relaxant reversal with sugammadex sodium was considered the likely cause of Takotsubo cardiomyopathy.

[Pentax-AWS Airwayscope for awake tracheal intubation in the face-to-face sitting position in an emergency patient with acute exacerbation of aortic stenosis].

We report a successful awake tracheal intubation in an emergency patient with acute exacerbation of aortic stenosis using the Pentax-AWS Airwayscope (AWS). An 83-year-old woman was admitted to our emergency department for severe dyspnea due to exacerbation of aortic stenosis. Her Sp(O2) was 92-93% even after administration of 10 l x min(-1) oxygen through a reservoir-attached face mask. As she could not remain in the supine position, emergency tracheal intubation in the sitting position was required. After topical anesthesia with 8% lidocaine and careful administration of midazolam, the AWS was inserted into her mouth in the sitting, face-to-face position. The AWS allowed for visualization of the glottis and safe placement of the tracheal tube. Sufficient spontaneous ventilation was maintained during interventions with minimum vital sign changes. Awake intubation in the sitting position with the AWS may be helpful in resolving cardiovascular crisis in patients unable to maintain the supine position.

[Shift of the i-gel position after chest compression: comparison of fixation methods using Durapore tape, Multipore tape, or a fixation strap].

BACKGROUND: The i-gel (Intersurgical, Wokingham, U.K.) is a newly developed, non-inflatable supraglottic device characterized by its soft, gel-like, and transparent mask made of thermoplastic elastomer. Although i-gel can be useful in emergency airway management during chest compression, the instability after insertion remains a problem. METHODS: We investigated the effectiveness of three fixation methods using a manikin and automated chest compressor. RESULTS: After 5-minute chest compression, i-gel without fixation was shifted by 0.56 +/- 0.17 cm, which was greater than with Durapore tape (0.28 +/- 0.08 cm), Multipore tape (0.26 +/- 0.05 cm), or a fixation strap (0.04 +/- 0.05 cm). The shift of the position was smaller with strap fixation compared to Durapore or Multipore tape fixation. CONCLUSIONS: A fixation strap may be useful in stabilizing the inserted position of i-gel during cardiopulmonary resuscitation.