A&A practice
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Dandy-Walker syndrome is a rare congenital brain malformation that requires unique anesthetic considerations. We present a rare case of an 18-month-old boy with Dandy-Walker syndrome presenting with 17% total body surface area burns undergoing multiple general anesthetics for both operative and bedside procedures. Numerous lessons were learned during multiple anesthetics, which influenced and guided our subsequent anesthetic management. The preoperative assessment, risk for respiratory apnea, opioid management, risk for laryngospasm, and postoperative care of patients with Dandy-Walker syndrome were all lessons learned.
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Placement of a pulmonary artery catheter (PAC) is associated with complications such as entrapment or knotting. PAC entrapment in the heart, vena cava, or pulmonary artery is serious, potentially life-threatening, particularly if they are unrecognized. ⋯ Surgical exploration requiring cardiopulmonary bypass revealed that the PAC had passed through the tricuspid valve orifice and knotted itself around the anterior leaflet chordal structure. The catheter was unknotted, with the patient subsequently recovering without long-term sequelae.
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In this case, the novel use of high-flow nasal oxygen successfully treated severe hypoxia by delivering oxygen through a very narrow space between the bronchoscope and the tracheal wall. Removal of a foreign body from a child's lung can be associated with hypoxia and cardiorespiratory arrest. ⋯ This simultaneous use can compromise gas exchange, leading to hypoxia. In this case, high-flow nasal oxygen supplemented bronchoscope oxygenation to treat a severely hypoxic child and facilitate subsequent removal of a peanut without further incident.
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Eye drops such as topical β-blockers are widely used to treat glaucoma and other ocular diseases. We provide an overview of ophthalmic solutions, including β-adrenergic receptor antagonists, for anesthesiologists and others involved in perioperative care. We summarize current evidence about systemic effects of topical β-blockers and other commonly used ophthalmic agents such as parasympathomimetic eye drops, carbonic anhydrase inhibitors, nonsteroidal anti-inflammatory drugs (NSAIDs), and emerging products such as combinations of multiple substances. We call for careful preoperative assessment and perioperative management of individuals using eye drops, especially critically ill patients, children, or those undergoing major surgery.