A&A practice
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An increasing number of surgical procedures are performed in the ambulatory setting, leading to improved patient comfort and cost-effectiveness. Patients with suspected or known difficult airways represent a challenge when anesthetized. ⋯ We present 3 cases scheduled for day-case procedures with predicted difficult airways, where the feasibility of awake fiberoptic intubation is demonstrated in a Scandinavian fast track setting. Our hypothesis is that, with accurate preparations, intubation times are comparable with conventional intubation and that the procedure is associated with only minor patient discomfort.
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Case Reports
Central Sleep Apnea Post Vagal Nerve Manipulation and Stimulation During Neck Tumor Resection: A Case Report.
We describe a pediatric patient who underwent neck dissection for removal of a tumor and had unexpected transient central sleep apnea in the recovery room. To the best of our knowledge, this is the first report in the existing literature of central sleep apnea after surgical manipulation of the vagal nerve under anesthesia.
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Neonates with laryngeal webs pose unique challenges to the anesthesiologist. We present a 2-day-old neonate with aphonia and stridor who underwent microdirect laryngoscopy. Intraoperatively, a Cohen type 4 laryngeal web was diagnosed not immediately amenable to resection. ⋯ After endotracheal intubation, there was acute respiratory compromise and oxygen desaturation that improved moderately after urgent tracheostomy. A chest radiograph revealed a large pneumothorax. Our experience suggests that in the presence of high-grade laryngeal webs, the possibility of intraoperative development of pneumothorax should be considered if respiratory difficulties are encountered.
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Case Reports
Allergic Acute Coronary Syndrome (Kounis Syndrome) in a Young Woman During Spinal Anesthesia: A Case Report.
Kounis syndrome represents the concurrence of acute coronary syndromes or anginal pain with allergic, hypersensitivity, and anaphylactoid reactions that are increasingly found in clinical practice. We present a case of a young woman who experienced attacks of dyspnea, hypoxemia, and hypotension during and after spinal anesthesia. Based on the pattern of clinical symptoms and laboratory findings, she was retrospectively diagnosed with Kounis syndrome, even though no apparent trigger of hypersensitivity was found.
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This case describes a parturient with Barnes syndrome, a rare disorder characterized by subglottic stenosis, thoracic dystrophy, and small pelvic inlet, who underwent cesarean delivery of a neonate diagnosed with Barnes syndrome. Live simulation training was performed by multidisciplinary team to prepare for the spinal anesthetic, personnel flow between 2 operating rooms, and management of various airway scenarios for the newborn. ⋯ Airway evaluation revealed subglottic stenosis, tracheomalacia/bronchomalacia. Collaboration among perinatologists, obstetric/pediatric anesthesiologists, pediatric head and neck surgeons, and neonatologists was integral to perioperative management of both the mother and child.