A&A practice
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Opioid-free perioperative approaches hold promise to reduce opioid use after surgery and their associated side effects. Here, we report the perioperative analgesic plan of a patient who requested opioid-free care for an open partial hepatectomy. ⋯ However, as in this case, placing an epidural is not always an option due to contraindications such as infection, coagulopathy, or patient refusal. Our multimodal management plan provided an alternative opioid-free, epidural-free perioperative strategy that may prove useful for other patients undergoing similar surgeries.
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Midazolam is commonly used for sedation during procedures because of its relative safety and predictability. Still, some rare undesirable medication reactions have been described. ⋯ These symptoms ultimately resolved following reversal of the midazolam with flumazenil. Given the widespread and multidisciplinary use of midazolam, practitioners should be aware of the potential for rare adverse reactions and be prepared to manage these scenarios.
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Case Reports
Unexpected Obstruction of a Parker Flex-Tip Endotracheal Tube Caused by Outward Bending of Its Tip: A Case Report.
We report a case of Parker Flex-Tip endotracheal tube obstruction caused by its tip bending outward against the tube lumen. The Parker Flex-Tip tube tip is designed to bend inward to prevent damage to airway structures during intubation. ⋯ Moreover, the cross-sectional area of the openings on the side of the endotracheal tube, the "Murphy's eyes" which are ellipses, decrease because the openings are pulled parallel to their long axis. Outward bending of the tip can obstruct the tube.
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The coronavirus disease 2019 (COVID-19) pandemic has rapidly exposed health care system inadequacies. Hospital ventilator shortages in Italy compelled US physicians to consider creative solutions, such as using Y-pieces or T-pieces, to preclude the need to make decisions of life or death based on medical equipment availability. We add to current knowledge and testing capacity for ventilator splitters by reporting the ability to examine the functionality of ventilator splitters by using 2 high-fidelity lung simulators. Data obtained by the high-fidelity lung simulators included: tidal volume, respiratory rate, minute ventilation, peak inspiratory pressure, peak plateau pressure, and positive end-expiratory pressure.
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Comparative Study
Comparison of the Effectiveness of Different Barrier Enclosure Techniques in Protection of Healthcare Workers During Tracheal Intubation and Extubation.
The coronavirus disease 2019 (COVID-19; SARS-CoV-2) pandemic has created serious challenges to anesthesiologists. As hospitalized patients' respiratory function deteriorates, many will require endotracheal intubation. ⋯ The addition of an enclosure barrier during airway management minimizes the hazard by entrapping the droplets and possibly the aerosols within an enclosed space adding additional protection for health care workers. The aim of this study was to compare the effectiveness of different barrier enclosure techniques during tracheal intubation and extubation.