大塚 洋司

Background : GlideScope® Cobalt video laryngoscope is a new type of GlideScope® series. A reusable camera baton is inserted into a disposable plastic curved blade. The blade has 5 choices of size and can be used from infants to adults. The aim of the current study was to evaluate the efficacy of GlideScope® Cobalt in children. Methods : Endotracheal intubation was performed in 50 surgical children undergoing general anesthesia The length of time in intubation, percentage of glottic opening (POGO) score and optimizing procedures were recorded Results : 100% POGO score was obtained in 42 cases. Successful endotracheal intubation was performed in 47 cases and 37 patients were intubated within 1 minute. It took over 1 minute to intubate in 13 cases, because of the difficulty of tracheal tube maneuver. Particular children, mostly aged 6-8, had difficulty in matching the size of the blade because of the large difference between the sizes of blade 2 and that of blade 3. Conclusions : GlideScope® Cobalt is a useful tool in chidlren's airway management but it necessitates getting used to the tracheal tube maneuver and lacks the suitable blade size for 6-8 years old children.

Background : GlideScope® videolaryngoscope (GVL) is a novel indirect laryngogoscope for tracheal intubation. Both mid-size and large blades of the GVL are available for adult patients. The distortion of the anterior airway anatomy and cervical spine motion using the mid-size GVL is unknown. We compare the degree of anterior airway distortion and cervical spine movement during the use of the mid-size GVL compared with the large GVL. Methods : Twenty patients requiring general anesthesia and tracheal intubation were studied. Each patient underwent laryngoscopy with both mid-size and large GVLs. During each laryngoscopy, a radiograph for the lateral view of the head and neck was taken when the best view of the larynx was obtained. Based on the radiographs, independent radiologists evaluated anterior airway movement and cervical spine movement. Results : The tip of the mid-size GVL was anteriorly positioned during laryngoscopy, compared with large GVL. The distance between epiglottis and posterior laryngeal wall was longer with the mid-size GVL than with the large GVL. Both the mid-size and large GVL caused a significant anterior movement in the cervical spine during laryngoscope. The difference in the movement in the atlas and C2 was small, but statistically significant. No difference was found in the anterior movement with C3 and C4. During laryngoscopy, cervical spinal extension occurred with both GVLs, while there was no difference in the cervical spinal extension between the mid-size and large GVL. Conclusions : The tip of the mid-size GVL during laryngoscopy is anteriorly positioned and the distortion of the anterior airway was greater with the mid-size GVL than with the large GVL.

Helmet is a new device of non-invasive continuous positive airway pressure (CPAP). Few cases have been described about usage of the helmet in children. We describe successful treatment of a child with respiratory distress using the helmet-delivered non-invasive CPAP. A 2-month-old male infant (3.1 kg) with multiple anomalies (cardiovascular, facial, and vertebral) developed respiratory distress after extubation. The helmet was well tolerated regardless of facial anomaly. Helmet CPAP started at initial settings of CPAP 8 cm H2O and FIO2 0.7, improved oxygenation. PaO2/FIO2 ratio increased from 106 to 316, and chest X-rays showed a marked improvement (15 hour after NPPV initiation). The helmet offers important advantage : the possibility of fitting to any children, regardless of any facial or external anomalies.

Surgical exposure and accurate closure of a ventricular septal defect with a membranous septal aneurysm beneath the septal tricuspid leaflet carries a risk of tricuspid valve dehiscence and conduction disturbances when the septal leaflet is detached along the tricuspid annulus. To avoid these problems, we use a radial incision to expose and close perimembranous ventricular septal defects. We reviewed recent cases to determine the risks and benefits of this technique. From January 2005 through September 2008, 30 patients underwent closure of a perimembranous ventricular septal defect through a right atrial approach at our institution. The operation included radial incision of the membranous septal aneurysm to improve visualization of the perimembranous ventricular septal defect in 9 patients. There was no perioperative or late death. The operative and postoperative courses were uneventful in all cases. A residual leak was detected in only one patient. No patient had more than mild postoperative tricuspid valve insufficiency, none underwent reoperation, and no new arrhythmia or conduction disturbance was detected during follow-up. The radial incision for closure of a ventricular septal defect with a membranous septal aneurysm provides satisfactory exposure of the defect through the right atriotomy, for safe and accurate closure. © 2010 SAGE Publications.

Background : The GlideScope® video laryngoscope (Verathon Inc. Bothell, Washington, USA) is a relatively new device for tracheal intubation, which provides a excellent glottic visualization. We here report the clinical experience of the GlideScope® (small) in 50 pediatric patients. Methods : Tracheal intubation with GlideScope® (small) was performed in 50 consecutive pediatric patients requiring orotracheal intubation for surgery. The view of glottic opening was scored according to the classification of Cormack-Lehane. The time required to intubate and the number of intubation attempts were recorded. Results : In all, 50 children included 4 neonates, 8 infants under 1 year and 38 children between 1 year and 9 years. Cormack-Lehane classification 1 or 2 was obtained in 74% and 22%, respectively, and successful intubation was achieved in 48 of 50 children (96%). In remaining two babies, GlideScope® failed to intubate the trachea. The mean±SD time for instrumentation in successful intubation at first attempt was 56.6±34.2 seconds. Conclusions : GlideScope® seemed to be a novel device in pediatric patients. Further studies are required to evaluate the usefulness in neonates, small infants and children with a difficult airway.

Increasing evidence indicates that the GlideScope® video laryngoscope (GVL) has an established role in endotracheal intubation. The GVL has been on the market in Japan. In this report, we introduced the clinical performance of the GVL. The GVL has been reported to provide a better glottic exposure compared with the direct laryngoscope in normal and difficult airways. In addition, the GVL has been reported to have superior performance, compared with direct laryngoscope when used for nasotracheal intubation. The GVL is a novel indirect rigid laryngoscope for routine endotracheal intubation.

The purpose of this study was to evaluate the performance of the GlideScope videolaryngoscope for tracheal intubation by novice laryngoscopists compared with that of the Macintosh laryngoscope. Under supervision by staff anesthetists, non-anesthesia residents performed tracheal intubation using either the GlideScope videolaryngoscope (n = 100) or Macintosh laryngoscope (n = 100). The time required for airway instrumentation, the number of attempts required until successful intubation, and erroneous esophageal intubation were investigated. There were no significant differences in the time needed to secure the airway between the GlideScope videolaryngoscope and the Macintosh laryngoscope. Fewer attempts until successful intubation were made with the GlideScope videolaryngoscope than with the Macintosh laryngoscope (p < 0.05). Erroneous esophageal intubation with the GlideScope videolaryngoscope was less frequent than with the Macintosh laryngoscope (p < 0.05). Compared to the Macintosh laryngoscope, the GlideScope videolaryngoscope reduces the incidence of erroneous esophageal intubation by less experienced laryngoscopists.

Background : Since the diagnosis procedure combination (DPC) for health insurance plans in Japan was started in medical practice, the number of surgical procedures is increasing at teaching hospitals. Methods : We retrospectively surveyed 8,672 surgical procedures performed at the central surgical unit of the Jichi Medical University Hospital from April 1, 2007 to March 31, 2008. Results : Of the 8,672 surgical procedures, 6,922 operations were performed under the management of anesthesia staffs, and 1,904 procedures (27.5%) were done in emergency situation. Central surgical unit has 14 operating rooms and an estimated maximum number of surgical procedures is 7,700. Conclusions : This survey revealed that the present status of manpower of anesthesiologists at our hospital was insufficient for the work. In particular, the demands for anesthesiologists have increased in emergency operations including major cardiovascular surgery, neurosurgery and liver transplantations.