A&A practice
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An operating room (OR) fire is a rare event but may cause critical harm to patients and health care personnel. We present 2 fire incidents in the rear cabinet of an anesthesia machine, not previously reported in the literature. ⋯ In another case, the fire erupted while surgery was in progress. Here, we discuss the management of an anesthesia machine fire and emphasize the need for improved fire safety in advanced anesthesia machines.
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Commercially available bite blocks used for invasive imaging procedures have design limitations, including bulky profile, being made of hard plastic that may damage surrounding tissue, and tendency to dislodge. We designed a novel bite block to address these limitations and evaluated this bite block in 50 patients undergoing diagnostic or intraprocedural transesophageal echocardiography examinations. Nine of 11 (82%) imagers who used the redesigned bite block preferred it over the standard bite block used at our institution. The novel bite block is an alternative device to standard bite blocks that was redesigned to protect both the patient and probe.
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Case Reports
Bedside Diagnosis of Pulmonary Embolism Using Electrical Impedance Tomography: A Case Report.
Electrical impedance tomography (EIT) is an emerging imaging modality that can be used to diagnose ventilatory and intrathoracic perfusion mismatches in unstable patients at the bedside. We present a case of a postoperative hypoxic patient in the intensive care unit (ICU) who was too unstable for transport for computed tomography (CT) imaging but was diagnosed and treated for a pulmonary embolism using EIT at the bedside. After the patient clinically improved, CT imaging confirmed the pulmonary embolism diagnosis. EIT is a promising diagnostic tool that may have great utility in ICUs, where it can be safely applied at the bedside.
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An intertransverse process block (ITPB) is a paraspinal thoracic nerve block technique, where the local anesthetic (LA) is injected into the thoracic intertransverse tissue complex posterior to the superior costotransverse ligament (SCTL). Although an ITPB can be ultrasound-guided, it is performed using surrogate bony landmarks without even identifying the SCTL. This report describes a transverse ultrasound imaging technique to identify the retro-SCTL space and perform an ITPB with a retro-SCTL space injection, in 2 patients undergoing video-assisted thoracoscopic surgery. The resultant bilateral, symmetrical, thoracolumbar anesthesia was consistent with epidural spread of the LA and effective for perioperative analgesia.
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It is controversial whether fetal delivery improves maternal oxygenation during mechanical ventilation. We evaluated maternal arterial partial pressure of oxygen (Pao2) to fractional oxygen concentration (Fio2) (P/F) ratios before and after delivery in this series of 15 parturients with coronavirus disease 2019 (COVID-19). ⋯ Five patients required emergent bedside delivery. We discuss numerous considerations guiding delivery planning during mechanical ventilation.