A&A practice
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Tetra-amelia is a rare congenital disorder characterized by the absence of limbs. We describe the anesthetic management of a 29-year-old woman with tetra-amelia who underwent general anesthesia for tympanomastoidectomy with meatoplasty for an extensive right ear cholesteatoma. Anesthetic challenges related to tetra-amelia include difficult intravenous access, lack of sites for blood pressure monitoring, and possible difficult airway management due to craniofacial anomalies. Our case report focuses on the complex establishment of iliac artery access for invasive blood pressure monitoring by initially cannulating the carotid artery.
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Case Reports
Echo Findings of Intraoperative Surgical Glue Remnant on the Aortic Valve: A Case Report.
Surgical adhesive agents are frequently applied to reinforce aortic sutures in cardiac and aortic surgery. They are thought to provide hemostasis and safely and effectively reduce morbidity. ⋯ For detection of such surgical glue remnants, and to prevent associated serious potential complications, comprehensive transesophageal echocardiography is important. If surgical glue is applied during operative procedures, the heart and aorta should be carefully examined by transesophageal echocardiography.
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Previous case reports describing fire during left internal mammary artery dissection involved patients with pulmonary blebs and did not involve the airway. We present a case of an airway fire, diagnosed by the sound of a pop, the appearance of a spark, and the development of an airway circuit leak in a patient with a 4-year-old tracheostomy scar who presented for coronary artery bypass with a left internal mammary artery. The case description is followed by a brief discussion of operating room fires and their management.
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Spinal anesthesia is practical and safe in infants and toddlers and prevents perioperative complications including cardiorespiratory instability and apnea. Other perioperative advantages include reduced time from surgery completion to operating room exit and first feed. ⋯ The infant remained calm and stable throughout the uneventful procedure and postoperative period. Spinal anesthesia may be feasible for laparoscopic herniotomy when pneumoperitoneum pressure and operative time are restricted to 8 mm Hg and 60 minutes, respectively, with sensory level at T10 or higher.