title: [Endotracheal intubation in an adult patient fitted with a Leksell frame using a Pentax Airwayscope with a pediatric-type INTLOCK blade (ITL-P)].
abstract: Several previous reports have established the Pentax Airwayscope (Pentax AWS, S-100, HOYA-PENTAX, Tokyo, Japan) as an efficient tool for tracheal intubation in adult patients. The Pentax AWS is often successfully used with an INTLOCK blade; to date, however, INTLOCK blades have been released for neonatal and pediatric patients only. In this case, we performed tracheal intubation using a Pentax AWS attached to a pediatric-type INTLOCK blade (ITL-P) in an adult patient fitted with a Leksell Stereotactic frame (Elekta, Sweden). The patient weighed 45 kg and was 154 cm tall, and was scheduled for a tumor biopsy due to glioblastoma in the brain stem. The patient was preoperatively fitted with a Leksell frame on her head. The patient was not premedicated and was monitored with electrocardiography (ECG), noninvasive blood pressure, and pulse oximetry. Following pre-oxygenation, general anesthesia was induced using propofol 4.0 microg x ml with target-controlled infusion and remifentanil 0.25 microg x kg(-1) hr(-1). After loss of consciousness, we administered 30-mg rocuronium boluses. We initially attempted tracheal intubation first using a Macintosh laryngoscope and then a Pentax AWS, but we could not achieve tracheal intubation with either of these instruments. Upon switching to a Pentax AWS with an ITL-P, we successfully achieved tracheal intubation without any complications. Anesthesia was maintained uneventfully with 3.0 microg x ml(-1) propofol and remifentanil 0.10 to 0.25 microg x kg(-1) x hr(-1) in oxygen and air. Further study is needed to facilitate the effective use of the Pentax AWS and the ITL-P in such cases.
authors.forename: Risa
authors.initials: R
authors.lastname: Takeuchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Hoshijima
authors.forename: Yuta
authors.initials: Y
authors.lastname: Horikoshi
authors.forename: China
authors.initials: C
authors.lastname: Nakamura
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Iwase
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Nagasaka
mesh_terms: D000328:Adult; D000768:Anesthesia, General; D001932:Brain Neoplasms / Q000601:surgery; D001933:Brain Stem; D005260:Female; D005909:Glioblastoma / Q000601:surgery; D006801:Humans; D007442:Intubation, Intratracheal / Q000295:instrumentation* / Q000379:methods; D020704:Laryngoscopes; D010880:Piperidines; D015742:Propofol; D000077208:Remifentanil
chemical_list: D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol