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A 71-year-old man was scheduled to undergo cardiac resynchronization therapy device (CRTD) implantation. He was combined with severe chronic heart failure due to ischemic heart disease. NYHA class was 3 to 4 and electrocardiogram showed non-sustained ventricular. Ejection fraction was about 20% revealed by transthoracic echocardiogram. He was also on several anticoagulation medications. We planned to implant the device under the greater pectoral muscle. As general anesthesia was considered risky, monitored anesthesia care utilizing peripheral nerve block and slight sedation was scheduled. Pectoral nerves (PECS) block and intercostal block was performed under ultrasonography with ropivacaine. For sedation during the procedure, continuous infusion of dexmedetomidine without a loading dose was performed. The procedure lasted about 3 hours, but the patient showed no pain or restlessness. Combination of PECS block and intercostal block may provide effective analgesia for CRTD implantation.

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Muscle relaxation appears to facilitate ProSeal insertion efficacy by enabling higher successful insertion rates, higher sealing pressure, lower leakage volume, and lower subjective difficulty of insertion in anesthetized patients.

We conclude that the AWS is an effective device for endotracheal intubation during chest compression not only on the bed but also on the ground.

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To compare tracheal intubation with the Pentax Airway Scope (AWS) and the Macintosh laryngoscope (McL) during chest compression, 25 anesthesiologists (including 12 specialists having >5 years of experience and 13 trainees having <2 years of experience) performed tracheal intubation using either the McL or the AWS, with or without chest compression, on a manikin. Using the McL, both specialists and trainees took a significantly longer time (P < 0.01) to secure the airway with chest compression (17.3 +/- 3.7 and 22.5 +/- 8.0, respectively) and than without chest compression (11.3 +/- 2.9 and 13.9 +/- 4.4 s, respectively). No significant difference was observed in time needed to secure the airway using the AWS with or without chest compression in both groups. From the standpoint of experience, time to complete intubation for specialists using the McL during chest compression was significantly shorter than that for trainees. In contrast, the difference in time to complete intubation with the AWS during chest compression was not significantly different between the two groups. Based on these results, we conclude that the use of the AWS may reduce the time needed to secure the airway during chest compression.