A&A practice
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Case Reports
Opioid-Obviating Analgesia for Adolescent Multilevel Spinal Fusion Surgery: A Problem-Based Learning Discussion.
A female teenager with a history of polysubstance use, including a recent overdose, is scheduled for multilevel posterior spinal fusion surgery due to idiopathic scoliosis and has asked to avoid the use of opioids in the context of her upcoming surgery. This problem-based learning discussion (PBLD) focuses on the examination of the care of a spinal fusion patient that allowed for the successful provision of opioid-obviating care.
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Incomplete neurological awakening manifested as aberrant patterns of electroencephalography (EEG) at emergence may be responsible for an unresponsive patient in the postanesthesia care unit (PACU). We describe a case of an individual who remained unresponsive but awake in the PACU. ⋯ We explored parallels with diminished motivation disorders and anesthesia-induced sleep paralysis due to imbalances in anesthetic drug sensitivity between brain regions. Our findings highlight the relevance of end-anesthesia EEG patterns in diagnosing delayed awakening.
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The anesthesia gas scavenging system (AGSS) removes waste gases from the anesthesia machine. Within the AGSS, safety features prevent excessive pressures from affecting ventilation. ⋯ Both cases suffered delayed identification intraoperatively but patients did not experience postoperative complications. These cases highlight the importance of daily scavenger system prechecks, the potential physiologic implications of AGSS malfunctions, and the importance of preplanned contingencies for machine failure.
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Case Reports
Life-Threatening Tracheal Tube Obstruction by Vernix Caseosa in a Newborn: A Case Report.
Accurate diagnosis and optimal management of sudden intraoperative ventilatory failure is crucial in children. Herein, we report the case of a newborn who underwent pacemaker implantation immediately after birth via cesarean delivery. ⋯ Diagnosis of tracheal tube obstruction was challenging because the obstruction occurred immediately after airway suctioning, which is performed to rule out tracheal tube obstruction. Anesthesiologists must consider airway obstruction from high-viscosity vernix caseosa as a possibility immediately after airway suctioning in newborns.