A&A practice
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Case Reports
From Tracheal Stenosis to Tracheostomy Displacement: A Case Report on a Seemingly Never-Ending Difficult Airway.
We report a case of undiagnosed tracheal stenosis that culminated in acute respiratory failure in an inpatient unit. After failed intubation attempts, the placement of a supraglottic airway resulted in successful ventilation and was followed by a tracheostomy in the operating room. Postoperatively, the tracheostomy tube became accidentally dislodged necessitating emergency measures with eventual reinsertion of a longer tracheostomy tube. We present this case to highlight life-saving airway strategies that may be considered in such emergency situations and propose 2 simple algorithms to guide anesthesiologists in managing similar airway emergencies.
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This case report describes a neonate with tracheal aplasia first diagnosed after birth due to the presentation of respiratory distress, absence of crying, and unsuccessful tracheal intubation. The most common finding with tracheal aplasia is polyhydramnios. ⋯ The only lifesaving treatment available is ventilation through esophageal intubation or tracheostomy. However, in some cases, tracheostomy is not an option.
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Case Reports
Effective Use of Angiotensin II in Coronavirus Disease 19-Associated Mixed Shock State: A Case Report.
The rapid spread of Coronavirus Disease 2019 (COVID-19) has sparked a search for effective therapies. The discovery that the virus binds the angiotensin-converting enzyme 2 (ACE2) receptor has led to investigation of the renin-angiotensin system for possible therapeutic targets. ⋯ She rapidly demonstrated significant hemodynamic improvement without noted adverse effects. Thus, we propose further investigation into possible benefits of angiotensin II in shock secondary to COVID-19.
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Case Reports
Pectoral Nerve Block Type II as the Sole Anesthetic for Removal of a Large Axillary Tumor: A Case Report.
The pectoral nerve block type II (Pecs II block) combined with general anesthesia provides analgesia during breast and axillary surgery. This report describes the first use of the Pecs II block as the sole anesthetic for axillary surgery. A patient needed resection of axillary masses. ⋯ An ultrasound-guided Pecs II block was performed. Both masses were resected without additional sedation or analgesia. This case report suggests that, in selected cases, the Pecs II block can be used as the sole anesthetic for axillary surgery.
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Case Reports
Placement of a Double-Lumen Endotracheal Tube Using a Combined Bronchoscopy and Fluoroscopy Technique: A Case Report.
Bronchial artery embolization (BAE) is a well-established intervention for hemoptysis that requires airway management by a trained anesthesiologist. The use of fluoroscopic guidance for positioning a double-lumen endotracheal tube (DLT) has been described in previous studies. The case presented illustrates a combined fluoroscopic- and bronchoscopic-guided approach for positioning a DLT in a patient with active pulmonary hemorrhage causing obstruction of views on bronchoscopy. This combined technique proved valuable in a situation marked by high clinical urgency.