A&A practice
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A novel coronavirus pandemic may be particularly hazardous to health care workers. Airway management is an aerosol-producing high-risk procedure. To minimize the production of airborne droplets, including pathogens such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), from the endotracheal tube during procedures requiring lung deflation, we devised a technique to mitigate the risk of infection transmission to health care personnel.
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Case Reports
Two Case Reports of Upper Extremity Venous Thrombosis From Midline Catheter Placement in Pregnancy.
Midline catheters are often inserted in pregnant women for whom a prolonged hospital stay is anticipated to facilitate the administration of medications and for blood sampling. Midline catheters compared with peripheral intravenous catheters are associated with fewer venipunctures and scheduled line changes. We present 2 cases of pregnant women with no personal or family history of thrombosis who underwent midline catheter insertion and developed venous thromboembolism of the upper extremity requiring anticoagulation therapy. Studies are needed to evaluate the safety profile of midline catheters in pregnancy.
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The relatively high cost of sugammadex compared to neostigmine limits its widespread use to reverse neuromuscular blockade, despite its faster onset and more complete clinical effect. While ensuring timely access to sugammadex is important in improving perioperative safety, it is also vital to control unnecessary spending. ⋯ Monthly spending on sugammadex decreased by 52% ($70,777 vs $33,821), while medication access increased via automated medication dispensers in each operating room. Clinical usage decreased by one-third, with presumed increased adherence to dosing guidelines.
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Critically ill patients with coronavirus disease 2019 (COVID-19) have been observed to be hypercoagulable, but the mechanisms for this remain poorly described. Factor VIII is a procoagulant factor that increases during inflammation and is cleaved by activated protein C. To our knowledge, there is only 1 prior study of factor VIII and functional protein C activity in critically ill patients with COVID-19. Here, we present a case series of 10 critically ill patients with COVID-19 who had severe elevations in factor VIII activity and low normal functional protein C activity, which may have contributed to hypercoagulability.