Journal of clinical anesthesia
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Case Reports
Transpleural subclavian central venous catheter placement in a child with scoliosis discovered during a thoracotomy.
Placement of central venous catheters in dysmorphic children can be difficult because of distortion of normal anatomical landmarks. We present such a case of a 16 year-old child who had a central venous catheter inserted in the left subclavian vein. Although a conventional roentgenogram was consistent with correct placement, the catheter was found to traverse the pleural space before entering the subclavian vein.
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We report a case of epidural catheter shearing, an uncommon complication of removal of a wire-reinforced epidural catheter. The catheter was removed without incident, and with the tip intact, after we allowed the patient to relax for 3 hours, placing the patient in the lateral decubitus position, and placing continuous tension on the catheter itself so as to let it "work its way out".
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Difficult airway management is a critical aspect of anesthesiology training and practice. A survey was conducted of American anesthesia residency programs to determine the prevalence of a specific airway rotation and its curriculum. ⋯ Of the programs with an airway rotation, the flexible fiberoptic bronchoscope and the laryngeal mask airway represent the most frequently used devices, excluding the standard laryngoscopes. There is minimum emphasis on more invasive techniques. Traditional methods of instruction continue to be utilized more frequently than nontraditional methods.