A&A practice
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Ambiguity in defining difficult intubation involving video laryngoscopy (VL) may pose potential risks to patients. To improve airway documentation practices, we surveyed anesthesia providers on their difficult intubation interpretations and VL use. ⋯ These results suggest that clinicians inconsistently interpret difficult intubations, especially in cases involving VL. There is a need for provider education and standardization of airway documentation, inclusive of VL.
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Case Reports
A Tale of 2 Tubes for Emergency Management of Airway Obstruction From an Anterior Mediastinal Mass: A Case Report.
Anterior mediastinal masses are challenging. As induction of general anesthesia may result in complete airway obstruction or hemodynamic collapse, maintaining spontaneous ventilation and advancing the endotracheal tube (ETT) distal to the mass are recommended. ⋯ Despite maintaining spontaneous ventilation, airway obstruction persisted following placement of the ETT proximal to the obstruction. After advancing the ETT into the right mainstem bronchus distal to the mass, hypoxemia persisted, prompting placement of a second ETT into the left mainstem bronchus to overcome the obstruction and provide adequate oxygenation.
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Dorsal root ganglion stimulation (DRG-S) has shown promise as a treatment for low back pain. The traditional anterograde placement of DRG-S leads can be challenging in patients with anatomical changes from prior back surgery. ⋯ At long-term follow-up, the patients experienced substantial pain relief and improvement in quality of life, with no complications. The outside-in lead placement technique may be an efficacious alternative to the traditional techniques in patients with anomalous anatomy from prior surgery.
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We report a series of 20 neonates and infants (18 born preterm) who underwent laparoscopic inguinal hernia repair with caudal anesthesia, oxygen via nasal cannula, and intravenous anesthesia. Surgery was successful in all cases without airway instrumentation or intraoperative complications. Sedation was provided with dexmedetomidine, propofol, and remifentanil. ⋯ Laparoscopy allowed unplanned bilateral repair in 2 cases. Caudal with intravenous anesthesia without airway instrumentation is a viable technique for laparoscopic inguinal hernia repair. Avoiding general endotracheal anesthesia may reduce perioperative complications and influence postoperative disposition.