A&A practice
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We report kinking of the pilot line of an endotracheal tube (ETT). The anesthesiologist found it difficult to deflate the ETT cuff after performing test inflation with air before intubation. ⋯ This examination revealed stenosis of the pilot line at the entry into the ETT, making it too narrow for air to flow freely during cuff deflation. The present case emphasizes that preanesthetic checking of the ETT cuff is very important.
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Case Reports
Carotid Endarterectomy in a Patient With Type 2 Myocardial Infarction During Preparation for Surgery: A Case Report.
We present a patient who was admitted for carotid endarterectomy due to tight carotid stenosis and recent amaurosis fugax. His medical history included significant coronary artery disease with stable angina pectoris, hypertension with wide pulse pressure, chronic renal failure, and anemia. ⋯ The patient posed a serious clinical dilemma whether to continue with surgery despite the type 2 myocardial infarction or postpone the surgery. We discuss the diagnostic tests and the decision-making processes that guided us in the preoperative period.
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Spontaneous coronary artery disease is an uncommon and likely underdiagnosed cause of sudden cardiac death affecting typically young and middle-aged women. We report a case of spontaneous coronary artery disease in the postoperative period in a female patient who developed an acute coronary event after gynecologic surgery. The patient was clinically asymptomatic except for mild hemodynamic instability and ST-segment-elevation myocardial infarction seen on electrocardiogram. Spontaneous coronary artery disease was diagnosed with coronary angiography, and a pharmacological therapy was instituted with favorable results.
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Intravenous lidocaine is increasingly being utilized as an opioid-sparing analgesic. A 55-year-old man with well-controlled human immunodeficiency virus on highly active antiretroviral therapy was prescribed a lidocaine infusion at 1 mg/kg/h for postoperative pain. On postoperative day 2, the patient experienced 4 unresponsive episodes with tachycardia, hypertension, and oxygen desaturation. ⋯ There is significant pharmacokinetic interaction between lidocaine and this patient's human immunodeficiency virus medications. This case highlights the need for a readily accessible list of medications that caution against lidocaine. We propose in-house serum lidocaine levels to monitor patients at an increased risk for toxicity.
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In severe pediatric acute respiratory distress syndrome, data are lacking on methods to measure and set optimal positive end-expiratory pressure. We present a 2-year-old girl with Trisomy 21 who developed severe pediatric acute respiratory distress syndrome and refractory hypoxemia from human metapneumovirus pneumonia. ⋯ The patient improved and survived without sequelae. Our case suggests that transpulmonary pressure monitoring should be studied as an adjunct to improve outcomes in pediatric acute respiratory distress syndrome.