[Comparison of airway scope and videolaryngoscope portable VLP-100 in the presence of a neck collar--a manikin study].

BACKGROUND: Tracheal intubation should be performed with great care in the multiple injury patient, particularly when damage to the cervical spine is suspected. The patient with unstable cervical spine requires a neck collar in prehospital area, and medical personnel may be required to perform tracheal intubation. We compared Macintosh laryngoscope with the Airway Scope (AWS), and Coopdeck videolaryngoscope portable VLP-100 (VLP-100) in a manikin model with the presence of a neck collar. METHODS: We conducted a prospective study in 20 medical residents with little prior airway management experience. They inserted the AWS, VLP-100 and Macintosh laryngoscope, in turn, and the view of the glottis at laryngoscopy was graded, using a classification reported by Cormack and Lehane. Tracheal intubation time and the success rate of tracheal intubation (within 120 sec) were also recorded. RESULTS: The AWS provided a best view of the glottis, a shorter tracheal intubation time and a higher success rate of tracheal intubation, compared with VLP- 100 and Macintosh laryngoscope. CONCLUSIONS: The AWS may possess advantages over conventional direct laryngoscopes in patients with restricted neck movement.

[A case of craniofacial injury by javelin].

We report a case of 16-year-old woman with craniofacial impalement injury by javelin (used by athletic sports) thrown from a distance of 30 meters. When the patient was admitted to the emergency department, the javelin had been in the orbita, and the patient was assessed by trauma team including an anesthesiologist. The patient was alert and complained of severe pain. Head CT and X-ray indicated the javelin had entered though the orbita into the maxillary sinus. Sphenoidal sinus was also partly destroyed by the impact. Anesthesia was soon induced in the emergency room to release the patient from the unbearable pain. To avoid tension cephalus, awake fiberscopic endtracheal intubation was performed. Anesthesia was maintained with propofol, vecuronium and fentanyl before transporting the patient to an operating room. The javelin and her head were strongly fixed with fiber cast to prevent from moving while she was transported to the operating room. The javelin was successfully removed during the operation. The fractures were fixed, and lacerations were sutured. The most important principle of management with craniofacial impalement injury is that the impaling object should remain in situ while patient is rapidly transported to an operating room, since it could extend tissue injury, and have a tamponade-like effect on damaged vascular structure.

[Successful anesthetic management of three patients with cardiac dysfunction for non-cardiac surgery using olprinone hydrochloride].

Non-cardiac surgery presents significant risks to patients with cardiac dysfunction. The relative safety of different anesthetic techniques has been studied without mentioning any clear indication. The depression of myocardial contractility by anesthetic agents limits their use in patients with cardiac dysfunction, especially for induction of anesthesia. We used olprinone hydrochloride perioperatively in the anesthetic management of three patients. In all cases, anesthetic induction, intraoperative course and the postoperative period proceeded uneventfully. We consider that perioperative use of continuous olprinone hydrochloride infusion may be suitable for patients with cardiac dysfunction for non-cardiac surgery.

[Assessment of peripheral blood perfusion during open heart surgery with sublingual PCO2 measured by ISFET-PCO2 sensor].

Sublingual tissue PCO2 (PSLCO2) was continuously monitored with an ISFET-based PCO2 sensor during and after the open-heart surgery under cardiopulmonary bypass (CPB) in order to study the effect of CPB on the peripheral blood perfusion. In addition, PSLCO2 monitoring was carried out in several cases of off-pump CABG. In the cases of open-heart surgery with CPB, PSLCO2 increased from 35.0 +/- 5.6 mmHg at the induction of anesthesia to the maximum value of 55.7 +/- 6.0 mmHg during CPB. After declamping of the aorta, PSLCO2 decreased gradually to 49.0 +/- 4.0 mm Hg 6 hr after the admission to ICU. The value of arterial lactate as another index of peripheral blood perfusion also increased gradually after the start of CPB, reaching to the maximum value of 8.8 +/- 1.1 mmol.l-1 just after being admitted into ICU. In the case of off-pump CABG, PSLCO2 and arterial lactate showed a slight increase during the later part of the surgery, but the change was not so significant as in the case of open-heart surgery under CPB. Through this study, typical changing pattern of PSLCO2 during the open-heart surgery was recognized. The change of PSLCO2 always preceded that of arterial lactate. We also experienced one case in which early stage of hypoperfusion was detected through the monitoring of PSLCO2. These results suggest clinical advantages of PSLCO2 monitoring.