A&A practice
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Case Reports
Cervicothoracic Emphysema After Nasotracheal Intubation Attempt: A Life-Threatening Complication-A Case Report.
Nasotracheal intubation is a commonly used technique in elective oral and pharyngeal surgeries. This case report details an incident involving a young adult patient in which an attempt at nasotracheal intubation resulted in a life-threatening cervicofacial and thoracic emphysema. Although complications associated with nasotracheal intubation are rare, their potential severity necessitates a comprehensive preprocedural discussion and risk assessment with the surgical team to confirm its appropriate indication for each individual patient. This case underscores the need for increased awareness and readiness for managing rare but critical complications associated with airway management techniques.
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We report a case of a parturient with severe cardiac disease requiring elective termination of pregnancy. The patient underwent successfully monitored anesthesia care using remimazolam for dilation and curettage. ⋯ Remimazolam is an ultrashort acting benzodiazepine that is being used with increasing frequency in short procedures requiring sedation. Patients with complex cardiac comorbidities undergoing surgical procedures may receive maximum benefit from this novel medication due to its stable hemodynamic profile and rapid metabolism.
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Carbon dioxide gas emboli is a potentially fatal complication that occurs more frequently during laparoscopic hepatectomy compared to other laparoscopic surgeries. The patient featured in this report had massive gas embolism confirmed by intraoperative transesophageal echocardiography (TEE) that were associated with episodes of severe hypoxemia, hemodynamic instability, and right ventricular failure requiring conversion to open hepatectomy. Abrupt abdominal decompression resulted in massive hemorrhage from a previously undetected defect in the middle hepatic vein. The report demonstrates the successful management of gas embolism during laparoscopic hepatectomy even with a significant delay in vascular repair and highlights the critical role of TEE.
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Accurate self-assessments enhance learning and patient care, yet resident physicians self-assess poorly. We therefore tested the effects of a consider-the-opposite (CTO) cognitive debiasing technique on self-assessment accuracy among anesthesiology residents. ⋯ Communication/leadership self-assessment accuracy improved by 5.63% (95% CI 0.001%-16.9%), but this did not meet our prespecified threshold for a meaningful effect. These findings do not suggest a compelling effect of this CTO intervention on self-assessment accuracy among trainees.
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Evaluations performed before the day of surgery at perioperative clinics have been shown to reduce patient mortality and hospital lengths of stay. These clinics are becoming increasingly adopted worldwide. As the number of older patients undergoing surgery continues to increase, understanding the perspectives of this patient population regarding the preoperative evaluation process is essential to tailor care to their needs and preferences. ⋯ Preanesthesia assessments allow for bidirectional communication between patients and anesthesia providers, alleviating patient anxiety and allowing for vital patient information to be collected to enhance overall patient safety. Our findings indicate that preoperative assessment by an anesthesia provider is desired and valued by the older patient population, contributing to the evidence in support of the implementation of anesthesia preoperative clinics. More research is needed to determine whether tailoring preanesthesia assessments to better align with patient preferences will translate into enhanced patient-centered outcomes.