A&A practice
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In this case, the novel use of high-flow nasal oxygen successfully treated severe hypoxia by delivering oxygen through a very narrow space between the bronchoscope and the tracheal wall. Removal of a foreign body from a child's lung can be associated with hypoxia and cardiorespiratory arrest. ⋯ This simultaneous use can compromise gas exchange, leading to hypoxia. In this case, high-flow nasal oxygen supplemented bronchoscope oxygenation to treat a severely hypoxic child and facilitate subsequent removal of a peanut without further incident.
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Eye drops such as topical β-blockers are widely used to treat glaucoma and other ocular diseases. We provide an overview of ophthalmic solutions, including β-adrenergic receptor antagonists, for anesthesiologists and others involved in perioperative care. We summarize current evidence about systemic effects of topical β-blockers and other commonly used ophthalmic agents such as parasympathomimetic eye drops, carbonic anhydrase inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs), and emerging products such as combinations of multiple substances. We call for careful preoperative assessment and perioperative management of individuals using eye drops, especially critically ill patients, children, or those undergoing major surgery.
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Giant ovarian cystadenoma is a rare and often late presentation. The mass effect of such tumors can lead to profound respiratory and cardiovascular compromise, predominately through inferior vena cava compression, but also restriction of normal lung function through transdiaphragmatic mass effect and, as is seen in this case, cardiac tamponade. In this article, the authors outline an expedited program of preoperative optimization and a choreographed physiological assessment strategy to functionally assess the hemodynamic consequences of a giant ovarian mucinous neoplasm, thereby informing the safe conduct of anesthesia and surgery.
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Laryngoscopy and endotracheal intubation in patients with unstable cervical spines may cause pathological spinal motion and resultant cord injury. Cadaver and mathematical (finite element) models of a type II odontoid fracture predict C1-C2 motions during intubation to be of low magnitude, especially with the use of a low-force videolaryngoscope. Using continuous fluoroscopy, we recorded C1-C2 motion during C-MAC D videolaryngoscopy and intubation in 2 patients with type II odontoid fractures. In these 2 patients, C1-C2 extension and change in C1-C2 canal space were comparable to motions predicted by cadaver and finite element models and did not cause neurological injury.