A&A practice
-
This single-center retrospective study evaluated a protocol for the intubation of patients with confirmed or suspected coronavirus disease 2019 (COVID-19). Twenty-one patients were intubated, 9 of whom were found to have COVID-19. ⋯ COVID-19 patients had lower peripheral capillary oxygen saturation by pulse oximetry (Spo2) nadirs during intubation (Spo2, 73% [72%-77%] vs 89% [86%-94%], P = .024), and a greater percentage experienced severe hypoxemia defined as Spo2 ≤80% (89% vs 25%, P = .008). The incidence of severe hypoxemia in COVID-19 patients should be considered in the development of guidelines that incorporate high-flow nasal cannula and noninvasive positive pressure ventilation.
-
Tracheomediastinal fistula (TMF) is an uncommon condition and carries a high mortality. We report the anesthetic management of a patient with TMF using stent insertion via rigid bronchoscopy. ⋯ Initial intraoperative attempts to ventilate the lungs and overcome the air leak with high gas flow of 45 L/min via the side port of the bronchoscope resulted in a pneumothorax. This case report demonstrates that high-frequency jet ventilation can minimize the air leak and avoid barotrauma during anesthesia for TMF repair.
-
Phantom limb pain is a common condition occurring after amputations. Percutaneous peripheral nerve stimulation (PNS) has been reported to provide analgesia for established lower extremity phantom pain. ⋯ A percutaneous PNS lead placed adjacent to the patient's brachial plexus under ultrasound guidance provided analgesia of the phantom pain for several weeks. PNS of the brachial plexus may provide analgesia for patients with upper extremity phantom pain.
-
Symptomatic carotid artery disease stenosis warrants open surgical carotid endarterectomy (CEA). However, patients with continuous-flow left ventricular assist devices (CF-LVADs) present unique challenges when vasopressors and volume are used to maintain cerebral perfusion pressure after carotid cross-clamping. ⋯ We identify how preload, contractility, afterload, pump speed, mean arterial pressure, and anticoagulation should be addressed to maintain CF-LVAD outflow and cerebral perfusion during the procedure. Anesthesiologists can combine an understanding of continuous-flow physiology with invasive monitors to optimize cardiac output and cerebral blood flow during CEA procedures.
-
Thoracic fascial blocks have been included in multimodal analgesia for breast surgery. Fewer studies demonstrate its use as a regional anesthesia technique. The serratus anterior plane (SAP) block provides anesthesia to the lateral thoracic wall and the axilla, the surgical area of some breast surgeries, with a single injection. This article reports the use of the SAP block as an anesthetic technique for breast lumpectomy with axillary dissection ensuring good surgical conditions and patient safety.