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Perioperative airway management of a patient with Beckwith-Wiedemann syndrome
Tsukamoto, Masanori,Hitosugi, Takashi,Yokoyama, Takeshi The Korean Dental Society of Anesthsiology 2016 Journal of Dental Anesthesia and Pain Medicine Vol.16 No.4
Airway obstruction in pediatric patients always poses a challenge for anesthesiologists. Beckwith-Wiedemann syndrome causes various abnormalities such as macroglossia and omphalocele. Patients with these abnormalities often need corrective surgeries. Management of difficult airway caused by conditions such as macroglossia in patients with this syndrome could be challenging. We encountered a case of difficult airway in an infant with Beckwith-Wiedemann syndrome. It was predicted that macroglossia might cause difficult ventilation, intubation, and extubation. Preoperative assessment and preparations for difficult airway should be considered.
Body composition and hemodynamic changes in patients with special needs
Tsukamoto, Masanori,Hitosugi, Takashi,Esaki, Kanako,Yokoyama, Takeshi The Korean Dental Society of Anesthsiology 2016 Journal of Dental Anesthesia and Pain Medicine Vol.16 No.3
Background: Some patients with special needs exhibit intellectual disability, including deficits in cognitive skills and decreased quality of life. The purpose of this study was to retrospectively compare changes in body composition and hemodynamics during general anesthesia in patients with and without special needs. Methods: The backgrounds of patients who underwent oral maxillofacial surgery under general anesthesia were recorded from medical records. Intracellular water (ICW), extracellular water (ECW), stroke volume variation (SVV), and heart rate (HR) were recorded for 3 h after the start of anesthesia. Categorical data were compared using an unpaired t-test, and a P-value of less than 0.05 was regarded as significant. Numerical data were compared using the Bonferroni correction, and a P-value of less than 0.0125 was regarded as significant. Results: A total of 21 patients were included in the study: 10 patients without special needs (non-S-group) and 11 patients with special needs (S-group). There were no significant differences in patients' backgrounds, except with regard to height (P = 0.03). In both groups, ICW and ECW were maintained, although they were lower in the S-group compared to the non-S-group. SVV was maintained in both groups, although it was higher in the S-group than the non-S-group. HR was significantly lower in the S-group 1 h after induction of anesthesia (P < 0.003). Conclusions: Changes in hemodynamics due to body fluid imbalance should be monitored during general anesthesia, especially for patients with special needs.
Awake fiberoptic nasotracheal intubation for patients with difficult airway
Tsukamoto, Masanori,Hitosugi, Takashi,Yokoyama, Takeshi The Korean Dental Society of Anesthsiology 2018 Journal of Dental Anesthesia and Pain Medicine Vol.18 No.5
Awake fiberoptic nasotracheal intubation is a useful technique, especially in patients with airway obstruction. It must not only provide sufficient anesthesia, but also maintain spontaneous breathing. We introduce a method to achieve this using a small dose of fentanyl and midazolam in combination with topical anesthesia. The cases of 2 patients (1 male, 1 female) who underwent oral maxillofacial surgery are reported. They received $50{\mu}g$ of fentanyl 2-3 times (total $2.2-2.3{\mu}g/kg$) at intervals of approximately 2 min. Oxygen was administered via a mask at 6 L/min, and 0.5 mg of midazolam was administered 1-4 times (total 0.02-0.05 mg/kg) at intervals of approximately 2 min. A tracheal tube was inserted through the nasal cavity after topical anesthesia was applied to the epiglottis, vocal cords, and into the trachea through the fiberscope channel. All patients were successfully intubated. This is a useful and safe method for awake fiberoptic nasotracheal intubation.
Tsukamoto, Masanori,Hitosugi, Takashi,Yokoyama, Takeshi The Korean Dental Society of Anesthsiology 2017 Journal of Dental Anesthesia and Pain Medicine Vol.17 No.1
Nasotracheal intubation is generally a useful maxillofacial surgery that provides good surgical access for intraoral procedures. When nasotracheal intubation is difficult, laryngeal mask airway (LMA) insertion can be performed, and the flexible $LMA^{TM}$ (FLMA) is also useful for anesthetic management. However, the FLMA provides limited access to the mouth, which restricts the insertion of instrumentation and confines the surgical field available. Here, we present our experience using the FLMA airway management for dental treatment cases involving difficulty with intubation.
Poster Session : PS 0099 ; Cardiology : Morphological Variation of the Carotid Sinus Location
( Satoshi Furukawa ),( Satomu Morita ),( Katsuji Nishi ),( Masahito Hitosugi ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Background: Carotid sinus massage is widely used to detect carotid sinus hypersensitivityin patients presenting with syncope. Recent guidelines recommend 5 to 10 seconds of carotid sinus massage in supine and upright positions with beat-to-beat monitoring, but somebody did not respond to the procedure. Objectives: The aim of this study was to describe the common Carotid Artery Bifurcation (CB). Method and result: Measurements were performed on 100 cadavers by the direct inspection method. The vertebra level of CB was differently distributed in distance of the whole neck measured along the vertebral column between upper borders of C1- C2 to lower border of C5. 54% of the level of CB was asymmetrical between the right and left side. Conclusion: We showed the anatomical variation of carotid sinus location. Anatomical locations of the carotid sinus bifurcation indicated wide variability. This variation was found to have an impact on the pressure transmission at the carotid sinus region in those individuals that displayed the superior/inferior range of carotid sinus loci.