A 6-month-old boy was scheduled for a laryngeal mass excision and tracheal bougienage for secondary subglottic stenosis. Following successful excision of the laryngeal mass, a tracheal tube was temporarily extubated for tracheal bougination. However, tracheal re-intubation using a direct laryngoscope with the Miller blade failed because of mucosal swelling and bloody secretions. Following multiple intubation attempts, the patient's peripheral oxygen saturation had decreased to 52%. Immediately, a video laryngoscope was requested, and, by using the C-MAC® video laryngoscope, the patient was successfully re-intubated. Because pediatric patients are more vulnerable to desaturation, extreme caution should be used in securing airways even during a short apneic period. Using a video laryngoscope at the first intubation attempt would be useful for successful tracheal intubation.
Constriction, Pathologic ; Humans ; Infant* ; Intubation* ; Laryngoscopes* ; Male ; Oxygen ; Pediatrics

A 6-month-old boy was scheduled for a laryngeal mass excision and tracheal bougienage for secondary subglottic stenosis. Following successful excision of the laryngeal mass, a tracheal tube was temporarily extubated for tracheal bougination. However, tracheal re-intubation using a direct laryngoscope with the Miller blade failed because of mucosal swelling and bloody secretions. Following multiple intubation attempts, the patient's peripheral oxygen saturation had decreased to 52%. Immediately, a video laryngoscope was requested, and, by using the C-MAC® video laryngoscope, the patient was successfully re-intubated. Because pediatric patients are more vulnerable to desaturation, extreme caution should be used in securing airways even during a short apneic period. Using a video laryngoscope at the first intubation attempt would be useful for successful tracheal intubation.
Constriction, Pathologic ; Humans ; Infant* ; Intubation* ; Laryngoscopes* ; Male ; Oxygen ; Pediatrics

Diabetes mellitus is the most common metabolic disease characterized by elevated blood glucose, which results in damage to the heart, blood vessels, eyes, kidney, and nervous system. The incidence of diabetes mellitus has increased in Korea due to longer life expectancy or lifestyle improvement. Since diabetes affects multiple organs including the cardiovascular, neuroendocrine, and autonomic nervous systems, the risk of postoperative complications such as wound infection and cardiovascular events might be increased in patients with diabetes. In addition to postoperative complications, hypoglycemia or hyperglycemia in diabetes may also cause serious problems during surgery. Preoperative fasting and surgical stress may contribute to the derangement of the patient’s physiological status. For appropriate management of diabetic patients in the perioperative period, patients should be evaluated in detail preoperatively and their blood glucose levels should be checked repeatedly during the surgery and even after surgery. The present paper reviews preoperative, intraoperative, and postoperative management of patients with diabetes.

Kyphosis is a deformity characterized by anterior flexion of the vertebral column. When severe, kyphosis may decrease lung volume and compliance, leading to increased work of breathing and deterioration of pulmonary function. Moreover, postoperative respiratory failure is a common problem for patients with severe spinal deformities. We describe the successful case of general anaesthesia in a 71-year-old male patient with severe thoracolumbar kyphosis undergoing open surgery converted from robotic surgery.
Aged ; Compliance ; Congenital Abnormalities ; Humans ; Kyphosis ; Lung ; Male ; Respiratory Insufficiency ; Robotics ; Spine ; Work of Breathing

BACKGROUND: A pneumatic tourniquet is commonly used in orthopedic surgery. However, neuromuscular blocking agent can be sequestered in the isolated limb and be reabsorbed into the systemic circulation after tourniquet release, potentially delaying extubation. To investigate the change in the train-of-four (TOF) ratio after tourniquet release and correlate the TOF ratio change with the extubation time. METHODS: Forty patients undergoing unilateral total knee arthroplasty were enrolled. Before and after the pneumatic tourniquet release, 10 measurements of the TOF ratio were averaged and compared. Additionally, we investigated the correlation between the percentage change in the TOF ratio before and after tourniquet release and the extubation time. RESULTS: Among the 40 patient subjects, 30 showed a TOF ratio before tourniquet release and 10 showed only a TOF count. Of the 30 patients with a TOF ratio, 21 showed a TOF ratio increase after tourniquet release and 9 showed a TOF decrease; both increase and decrease were statistically significant (P < 0.001 and P = 0.008, respectively). The extubation time showed a weak negative correlation with the percentage change in the TOF ratio after tourniquet release (P = 0.004). CONCLUSIONS: In orthopedic surgery using a pneumatic tourniquet, neuromuscular function monitoring may be required to monitor the change in the effect of neuromuscular blocking agent before and after tourniquet release, which may help to improve anesthesia safety.
Anesthesia ; Arthroplasty* ; Extremities ; Humans ; Knee* ; Neuromuscular Blockade ; Neuromuscular Blocking Agents ; Neuromuscular Monitoring ; Orthopedics ; Tourniquets*

No abstract available.
Humans ; Liver Transplantation* ; Liver* ; Living Donors* ; Tissue Donors*

A 54-year-old male patient was scheduled for an elective pylorus-preserving pancreaticoduodenectomy combined with video-assisted thoracic surgery at our hospital. This patient had a history of intubation failure in other institutions due to an epiglottic cyst. An airway assessment of the patient was normal. A preoperative laryngoscopy revealed a bulging epiglottic mass covering most of the epiglottis and occupying most of the pharyngeal space. The patient was administered intravenous midazolam 1 mg, fentanyl 50 microg, and glycopyrrolate 0.2 mg. A bilateral superior laryngeal nerve block was then performed with 2% lidocaine 2 ml on each side. A 10% lidocaine spray was applied on to the oropharynx. After preoxygenation with 100% oxygen over 10 minutes, a rigid fiberscope with an optical stylet loaded with a 37 Fr double lumen endotracheal tube was inserted orally and passed into the glottic aperture. The patient was fully awakened after surgical procedure and was transferred to the recovery room after extubation.
Airway Obstruction ; Epiglottis ; Fentanyl ; Glycopyrrolate ; Humans ; Intubation* ; Laryngeal Nerves ; Laryngoscopy ; Lidocaine ; Male ; Midazolam ; Middle Aged ; Oropharynx ; Oxygen ; Pancreaticoduodenectomy ; Recovery Room ; Thoracic Surgery, Video-Assisted

Video-assisted thoracoscopic surgery for pediatric patients has gained popularity due to better outcomes than open surgery. For this procedure, one-lung ventilation may be necessary to provide an adequate surgical field. Confirming lung isolation is crucial when one-lung ventilation is required. Recently, we experienced a case in which one-lung ventilation was confirmed by ultrasonography using the lung sliding sign and the lung pulse in an infant. Since lung ultrasonography can be performed easily and quickly, it may be a useful method to confirm lung isolation, particularly in emergency surgeries with limited time, devices, and experienced anesthesiologists.
Emergencies ; Humans ; Infant* ; Lung* ; One-Lung Ventilation ; Thoracic Surgery, Video-Assisted* ; Thoracoscopy ; Ultrasonography*

No abstract available.
Anesthetics* ; Brain* ; Humans ; Infant, Newborn*