[Acute Postoperative Negative Pressure Pulmonary Edema Caused by the Compression of Brachiocephalic Artery].

We report a case of negative-pressure pulmonary edema occurring by tracheal obstruction caused by the brachiocephalic artery. The patient had deformed thorax with cerebral palsy, which deformed thorax placing the brachiocephalic artery high over the trachea, resulting in close and tight contact between the artery and trachea. Additional deformity of the thorax associated with myotonic attacks after general anesthesia might shorten the distance between the sternal notch and the vertebral body, resulting in the tracheal obstruction by the artery.

[Video Laryngoscopy Reduces the Incidence of Erroneous Esophageal Intubation: A Meta-analysis].

BACKGROUND: The aim of this meta-analysis is to compare the incidence of erroneous esophageal intubations by video laryngoscopy to that by direct laryngoscopy. METHODS: The systematic search, data extraction, critical appraisal, and pooled analysis were performed according the PRISMA statement. The odds ratio(OR) and 95% confidence interval (CI) were calculated by the Review Manager 5.2 software for dichotomous outcome. RESULTS: Eleven trials included 1425 tracheal intubations by video laryngoscopy and 1632 tracheal intubations by Macintosh laryngoscopy. Video laryngoscopy reduced the risk of erroneous esophageal intubations (OR 0.10, 95% CI 0.04-0.24, P < 0.00001, I2 : 0%) compared with Macintosh laryngoscopy. CONCLUSIONS: Our meta-analysis showed that video laryngoscopy would reduce the incidence of erroneous esophageal intubations.

[Tracheal Intubation Using the Pentax-AWS during Chest Compression: A Meta-analysis].

BACKGROUND: The aim of this meta-analysis is to evaluate the efficacy of the Pentax-AWS for tracheal intubation during chest compression, compared with that of the Macintosh laryngoscope. METHODS: The systematic search, data extraction, critical appraisal, and pooled analysis were performed according the PRISMA statement. The relative risk (RR), mean difference (MD), and their corresponding 95% confidence intervals (CIs) were calculated by the Review Manager 5.2 software for dichotomous and continuous outcomes, respectively. RESULTS: Twelve trials included 424 tracheal intubations by Pentax-AWS and 421 tracheal intubations by Macintosh laryngoscope. In studies examining novice laryngoscopists, successful intubation (RR1.4, 95% CI 1.1-1.6, P < 0.0007) and time for instrumentation (MD -7.7 sec, 95% CI -10.1 sec--5.4 sec, P < 0.00001) were improved using the Pentax-AWS. With respect to experts' hands there was no difference between the two devices in both of these outcomes. CONCLUSIONS: Compared to the Macintosh laryngoscopy, Pentax-AWS offers advantages for novice laryngoscopists during chest compression, while these benefits are not seen with experts' hands.

[Anesthetic Management of Patients Undergoing Single-lumen Tracheal Tube Ventilation with Artificial Pneumothorax in Thoracolaparoscopic Esophagectomy].

We report anesthetic management of patients undergoing single-lumen tracheal tube ventilation with artificial pneumothorax in thoracolaparoscopic esophagectomy in prone position. No adverse effect against respiratory and circulatory management was found during esophagectomy. Single-lumen tracheal tube ventilation with artificial pneumothorax potentially is a feasible method for thoracolaparoscopic esophagectomy in prone position.

[Successful tracheal intubation using the GlideScope AVL in a pediatric patient with Pierre Robin syndrome].

We report a successful use of GlideScope AVL in a pediatric patient with Pierre Robin syndrome. A 36-day-old boy weighing 2.8 kg with Pierre Robin syndrome presented for tracheostomy after several weeks of trial airway management in prone position, who had failed to relieve his obstructive apnea. The Pentax-AWS videolaryngoscope equipped with the neonate Introck could not visualize his glottic opening. The GlideScope AVL single-use video laryngoscope equipping the #1 stat captured the view of the vocal cords. A tracheal tube (2.5 mm ID) with 90 degrees angled stylet, however, did not advance into the glottic opening, colliding with the anterior wall of the larynx and/or the laryngeal ventricle. Bending the tip of the stylet in a direction opposite to the inherent memory of the tube facilitated the placement of the tube into the trachea

[GlideScope AVL single-use video laryngoscope].

BACKGROUND: The aim of this case series was to evaluate the performance of GlideScope AVL single-use video laryngoscope for the visualization of the glottis and endotracheal intubations. METHODS: Visualization of the glottis with GlideScope AVL single-use video laryngoscope was performed in 200 consecutive patients who required tracheal intubation for surgery. The time to complete instrumentation and the visualization of the glottis according to the Cormack-Lehane grade was recorded. RESULTS: GlideScope AVL single-use video laryngoscope provided the grade I view of the glottis in 156 patients and the gradeII view in 44 patients. Intubation with GlideScope AVL single-use video laryngoscope was successful in 199 of the 200 patients. The mean (+/- SD) time for instrumentation was 38 +/- 23 s for orotracheal intubation (n = 170) and 36 +/- 16 s for nasotracheal intubation (n = 28). CONCLUSIONS: GlideScope AVL single-use video laryngoscope could be an effective aid for airway management in surgical patients.

[Glidescope cobalt videolaryngoscope].

GlideScope Cobalt video laryngoscope is a novel indirect laryngoscope for tracheal intubation. It consists of a reusable high-resolution miniature video camera and light source, and a disposable transparent sheath that enshrouds the video camera, thereby preventing contact with the patient. To evaluate the per- formance of GlideScope Cobalt, endotracheal intubation was performed in 100 consecutive patients requiring tracheal intubation for surgery. The time to complete instrumentation, the visualization of the glottis by the Cormack-Lehane grade and optimizing procedures were recorded. GlideScope Cobalt allowed successful intubation in all patients examined, including two patients with difficult airway with the Macintosh laryngoscope. Endotracheal intubation was performed within one minute in 83 cases. GlideScope Cobalt provided Cormack-Lehane grade 1 or 2 visualization of the glottis in 100 patients. It was easily handled not only by experienced anesthetists but also by novice personnel. GlideScope Cobalt could be an effective aid to airway management in surgical patients.

[Cervical spine movement during bag-mask ventilation].

BACKGROUND: Every airway maneuver will cause some degree of neck movement. Ventilation via face-mask technique requires lifting the mandible (jaw thrust) to the facemask. A significant degree of cervical spine motion induced by bag-mask ventilation has been reported on human cadavers with destabilized cervical vertebrae. However, to our knowledge, no quantitative data have reported evaluating the effects of bag-mask ventilation on cervical spine motion in living humans. We measured the cervical spine movement during bag-mask ventilation. METHODS: Twenty patients requiring general anesthesia were studied. Each patient underwent bag-mask ventilation. Movements of cervical spine were measured by radiography in the same patient both at neutral head position and during bag-mask ventilation. RESULTS: The anterior movements of the vertebral bodies from baseline were 11.3 +/- 5.8 mm, 11.1 +/- 4.9 mm, 11.0 +/- 4.7 mm and 10.6 +/- 4.4 mm at the atlas, C2, C3, and C4 vertebrae, respectively, during bag-mask ventilation. The changes in angle during bag-mask ventilation were 7.4 +/- 4.5 degrees, 4.9 +/- 4.2 degrees, 1.7 +/- 3.2 degrees, and -0.1 +/- 2.3 degrees, at occiput/C1, C1/C2, C2/C3, and C3/C4 motion segments, respectively. The total change in angle between the occiput and C4 was 13.8 +/- 6.4 degrees (95% CI 10.9 degrees-16.8 degrees). CONCLUSIONS: The lifting the mandible causes both extension and anterior disposition in the cervical vertebrae.

[Comparison of Pentax-AWS, GlideScope Cobalt, and Macintosh laryngoscope in patients for nasotracheal intubation].

BACKGROUND: We compared the time for instrumentation in nasotracheal intubation using Pentax-AWS and Glidescope to that using the Macintosh laryngoscope in patients with normal airway. METHODS: After local ethics board approval, 60 patients requiring dental or oral surgery were allocated randomly to Pentax-AWS, Glidescope and Macintosh groups. One experienced anesthesiologist performed nasotracheal intubation in all patients. RESULTS: The times for instrumentation using Pentax-AWS and Glidescope, and Macintosh laryngoscope were 37 +/- 12s, 33 +/- 9s, and 30 +/- 12s, respectively. There were no differences among the three devices. CCONCLUSIONS: When operated by experienced anesthesiologists, both Pentax-AWS and Glidescope showed similar performance for nasotracheal intubation compared with Macintosh laryngoscope in normal airway patients.

[Efficacy of Glidescope video laryngoscope in difficult airways: a meta-analysis of randomized controlled trials].

BACKGROUND: Increased evidence indicates that the Glidescope video laryngoscope (GVL) is useful for difficult tracheal intubations. The aim of this meta-analysis was to assess the efficacy of the GVL in difficult tracheal intubations, comparing with that of Macintosh laryngoscopy. METHODS: The systematic search, data extraction, critical appraisal, and pooled analysis were performed according to the PRISMA statement. The relative risk (RR), mean difference (MD), and their corresponding 95% confidence intervals (CIs) were calculated by the Comprehensive Meta-analysis version 2.2.040 software for dichotomous and continuous outcomes, respectively. RESULTS: Fifteen randomized controlled trials including 860 tracheal intubations by GVL and 860 tracheal intubations by Macintosh laryngoscopy. GVL showed higher success rate (RR 1.065, 95% CI 1.017-1.117, P < 0.008) than does the Macintosh laryngoscope, whereas no difference was found in the duration for instrumentation. CONCLUSIONS: Our meta-analysis showed that GVL has an advantage over Macintosh laryngoscope in respect to the success rate for difficult tracheal intubations.

[Airtraq for difficult airways: A meta-analysis of randomized controlled trials].

BACKGROUND: Increased evidence indicates that the Airtraq is useful for difficult tracheal intubations. The aim of this meta-analysis was to assess the efficacy of the Airtraq in difficult airways, comparing with that of Macintosh laryngoscopy. METHODS: The systematic search, data extraction, critical appraisal, and pooled analysis were performed according to the PRISMA statement. The relative risk (RR), mean difference (MD), and their corresponding 95% confidence intervals (CIs) were calculated by the Comprehensive Meta-analysis version 2.2.040 software for dichotomous and continuous outcomes, respectively. RESULTS: Sixteen randomized controlled trials included 863 tracheal intubations by Airtraq and 865 tracheal intubations by Macintosh laryngoscopy. Airtraq showed higher success rate (RR 1.242, 95%CI 1.137 to 1.357, P<0.00001) and shorter duration for instrumentation (MD-8.259 s, 95%CI-13.122 s to-3.396 s, P <0.00087). CONCLUSIONS: There is considerable evidence that Airtraq has an advantage over Macintosh laryngoscope in difficult airways.

[Channeled videolaryngoscope: A meta-analysis of randomized controlled trials].

BACKGROUND: The aim of this meta-analysis was to assess the efficacy of the channeled videolaryngoscopes in routine tracheal intubation. METHODS: The systematic search, data extraction, critical appraisal, and pooled analysis were performed according to the PRISMA statement. We included randomized controlled trials in humans comparing Airtraq and Pentax-AWS to Macintosh laryngoscopy regarding the successful first-attempt and time for instrumentation. The relative risk (RR), mean difference (MD), and their corresponding 95% confidence intervals (CIs) were calculated for dichotomous and continuous outcomes, respectively. RESULTS: We included 20 trials with total of 2,370 patients. The channeled videolaryngoscopes showed higher success rate (RR 1.103, 95%CI 1.042 to 1.167, P <0.00069) and shorter duration for instrumentation (MD-10.873 s, 95%CI-18.588 s to-3.158 s, P< 0.0057). In studies examining novice laryngoscopists, successful first-attempt intubation (RR 1.28, 95%CI 1.14 to 1.45, P<0.000067) and time for instrumentation (MD-22.9 s, 95%CI-29.4 to-16.4, P<0.00001) were improved using the channeled videolaryngoscopes. With respect to experts' hands, there was no difference between the two devices in both of these outcomes for non-difficult intubations, while successful first-attempt intubation was improved for difficult intubations (RR 1.09, 95%CI 1.05 to 1.15, P<0.00011). CONCLUSIONS: Compared to the Macintosh laryngoscopy, channeled videolaryngoscopy offers advantages for novice laryngoscopists, while these benefits are not seen with experts' hands in normal airways. Even with skillful hands, channeled videolaryngoscopy improves the successful first-attempt intubation in difficult intubations.

[Cervical spine motion during laryngoscopy with the Pentax-AWS with a new thinner blade (Introck-T)].

BACKGROUND: The Pentax-AWS equipped with a new thinner blade (Introck-T) is an intubation device that provides a non-line-of sight view of the glottis. A non-line-of sight view is expected to cause less movement of the cervical spine during laryngeal visualization. We measured the degree of cervical spine movement during laryngoscopy with the device. METHODS: Twenty patients requiring general anesthesia were studied. Each patient underwent laryngoscopy using the Pentax-AWS with the Introck-T. Movements of cervical spine were measured by radiography in the same patient both at neutral head position and during laryngoscopy. RESULTS: The anterior movement of the vertebral bodies from baseline was 16.7 +/- 5.2 mm, 16.5 +/- 4.4 mm, 16.5 +/- 4.7mm and 15.5 +/- 4.7mm at the atlas (C1), C2, C3, and C4 vertebrae, respectively, during laryngoscopy. The change in angle during laryngeal visualization was 8.3 +/- 4.0 degrees, 7.6 +/- 3.7 degrees, 1.7 +/- 2.4 degrees, and 1.6 +/- 3.3 degrees, at Occiput/C1, C1/C2, C2/C3, and C3/C4 motion segments, respectively. The total change in angle between the occiput and C4 was 19.1 +/- 5.1 degrees (95% CI 16.6 degrees - 21.5 degrees). CONCLUSIONS: Laryngeal visualization using the Pentax-AWS with the new thinner Introck-T produces the anterior movement and extension of the cervical spine.

[Efficacy of Pentax-AWS in difficult airways: a meta-analysis of randomized controlled trials].

BACKGROUND: Increased evidence indicates that the Pentax-AWS (AWS) is useful for difficult airways. The aim of this meta-analysis was to assess the efficacy of the AWS in difficult airways, comparing that of Macintosh laryngoscopy. METHODS: The systematic search, data extraction, critical appraisal, and pooled analysis were performed according to the PRISMA statement. The relative risk (RR), mean difference (MD), and their corresponding 95% confidence intervals (CIs) were calculated by the Comprehensive Meta-analysis version 2.2.040 software for dichotomous and continuous outcomes, respectively. RESULTS: Eighteen randomized controlled trials, performed in simulated difficult airways (published between 2006, October and 2012, May), included 981 tracheal intubations by AWS and 986 tracheal intubations by Macintosh laryngoscopy. AWS showed higher success rate (RR: 1.220, 95% CI: 1.126 to 1.322, P < 0.00001) and shorter duration for instrumentation (MD: -10.319 s, 95% CI: -14.309 s to -6.328 s, P < 0.00001). CONCLUSIONS: There is considerable evidence that AWS has an advantage over Macintosh laryngoscope in difficult airways.

[Efficacy of videolaryngoscopes for nasotracheal intubation: a meta-analysis of randomized controlled trials].

BACKGROUND: Increased evidence indicates that the videolaryngoscope is useful for nasotracheal intubation. The aim of this meta-analysis is to assess the efficacy of videolaryngoscopes (Glidescope, Airtraq and Pentax-AWS) in nasotracheal intubations, comparing with that of Macintosh laryngoscopy. METHODS: The systematic search, data extraction, critical appraisal, and pooled analysis were performed according to the PRISMA statement. The relative risk (RR), mean difference (MD), and their corresponding 95% confidence intervals (CIs) were calculated by the Comprehensive Meta-analysis version 2.2.040 software for dichotomous and continuous outcomes, respectively. RESULTS: Seven randomized controlled trials included 294 tracheal intubations by videolaryngoscopes and 253 tracheal intubations by Macintosh laryngoscopy. Videolaryngoscopes showed higher success rate (RR 1.116, 95% CI 1.021-1.220, P < 0.0155, I2 : 51%) and shorter intubation time (MD -11.9 sec, 95% CI-18.9(-) -5.0 sec, P < 0.0008, I2 84%) compared with the Macintosh laryngoscope. CONCLUSIONS: Our meta-analysis showed that the videolaryngoscope has an advantage over Macintosh laryngoscope in nasotracheal intubations.

[Successful resuscitation in a life-threatening obstetric hemorrhagic patient with hematocrit 3%: a case report].

We report a postpartum woman who suffered from obstetric bleeding after caesarean section. Her lowest hematocrit was 3% when a large amount of blood was lost. "Guidelines for management of critical bleeding in obstetrics" published by the Japanese Society of Anesthesiologists and four related academic societies was helpful for the resuscitation of the parturient. A systematic approach was effective for the care of women with major obstetric hemorrhage.

[Case report of endotracheal intubation using AirWay Scope (Pentax-AWS) in a Forestier's disease patient].

A Forestier's disease patient was scheduled for endoscopic mucosal resection under general anesthesia, because of his hypoxic episode during gastric endoscopy. Endotracheal intubation was planned while awake, because he was suspected as a case of difficult airway. By using AWS, we could easily confirm his larynx and aditus of trachea in spite of his narrow pharynx caused by Forestier's disease. The procedure was successful with no complications. AWS seems to be a useful device for endotracheal intubation in Forestier's disease.

[Case of unexpected difficult intubation caused by asymptomatic congenital laryngeal web].

We report a case of unexpected difficult intubation in a patient with an asymptomatic congenital laryngeal web. A 44-year-old female with left ovarian tumor and endometrial polyp was scheduled for abdominal hysterectomy and left salpingo-oophorectomy under general anesthesia. With aid of laryngoscopy using Macintosh laryngoscope, we attempted to place a tracheal tube (ID 7.5 mm and 7.0 mm), but could not perform instrumentation because of the resistance against the tube just under the vocal cord. We visualized the glottic opening through the Airway Scope and found a membranous lesion at the ventral side of the glottis, diagnosing a congenital laryngeal web. We finally could insert a tracheal tube of ID 6.5 mm into the dorsal side of the glottis. Airway Scope may be a useful device for unexpected difficult tracheal intubation.

[Use of sugammadex in a patient with limb girdle muscular dystrophy].

Limb girdle muscular dystrophy, a chronic progressive muscular atrophic disease, leads to high sensitivity to depolarizing and non-depolarizing neuromuscular blocking agents. We report the successful use of the sugammadex in a patient with limb girdle muscular dystrophy (dysferlinopathy, Miyoshi distal myopathy) to reverse rocuronium-induced neuromuscular block. After neuromuscular recovery to a train-of-four ratio = 43%, we administered 3.2 mg x kg(-1) of sugammadex (200 mg) intravenously, reversing neuromuscular blockade to a train-of-four ratio = 95% within 3 min. Sugammadex can be used to reverse rocuronium-induced neuromuscular blockade in patients with limb girdle muscular dystrophy.

[Submental tracheal intubation for a panfacial fracture patient].

Panfacial fractures represent a unique challenge to the surgical and anesthetic team. Often nasal and oral intubations interfere with surgical procedure, while tracheotomies include a number of potential complications as well as the formation of poor scarring in a highly visible area. Tracheal intubation through the floor of the mouth, mentioned as submental tracheal intubation, is a simple quick and effective alternative to oral and nasal tracheal intubation or tracheostomy in the surgical management of selected patients with panfacial fractures. In this case report, with successful submental tracheal intubation, the potential complications associated with a tracheotomy were avoided.