A&A practice
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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.
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Case Reports
Use of the Novel C-MAC Video Stylet in a Case of Predicted Difficult Intubation: A Case Report.
Video laryngoscopes are commonly used to manage difficult airways, among other devices. However, they present a challenge when inserting the blade in patients with a limited mouth opening, and an adequate visualization of the glottis does not always translate into successful intubation. The C-MAC Video-Stylet-with its small diameter and flexible tip-offers an effective alternative. We describe the successful use of the novel C-MAC Video-Stylet to secure the airway in a patient with minimal mouth opening due to the side effects of previous neck surgery and radiation therapy.
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Case Reports
Repeat Subdural Hematoma After Uncomplicated Lumbar Drain Discontinuation: A Case Report.
Lumbar drains are commonly placed to monitor spinal cerebrospinal fluid (CSF) pressures and drain CSF to augment spinal cord perfusion. Excessive CSF drainage or persistent leakage through the dural puncture site can lead to cerebral hypotension and creation of an intracranial subdural hematoma. Anesthesia providers need to be aware of the risk of subdural hematoma development after major thoracoabdominal surgery where placement and subsequent removal of a lumbar drain have occurred. We present a patient who had recurrent subdural hematoma secondary to persistent undiagnosed CSF leak from the dural puncture site after uncomplicated placement and removal of a lumbar drain.