Journal of clinical anesthesia
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Placement of double-lumen endobronchial tubes (DLTs) into the trachea can be difficult because of their size and configuration. For patients with abnormal airway anatomy and anticipated difficult tracheal intubation, DLT placement can be extremely challenging. We present our experience using lighted stylets to facilitate insertion of DLTs in a series of patients with difficult airway anatomy.
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Case Reports
Emergency cesarean section in a patient with Fontan circulation using an indwelling epidural catheter.
Management of parturients with a history of Fontan procedure requires careful monitoring of cardiovascular parameters and anticipation of potential complications. We describe potential pitfalls in a parturient with atriopulmonary Fontan circulation, who received epidural analgesia for labor and who later required emergency cesarean section. Low-dose local anesthetic in combination with meperidine provided excellent perioperative epidural analgesia and cardiovascular stability. Epidural analgesia during labor offered optimal pain relief and facilitated conversion to surgical anesthesia for an emergency cesarean section.
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Smoking is the single most cause of preventable disease and premature death in the United States. We discuss potential hazards that the anesthesiologist should be aware of when caring for patients who abuse tobacco. A review of recent preoperative smoking cessation initiatives is also provided in addition to recommendations on how anesthesiologists may use the preoperative visit as an opportunity to play a more active role in reducing the burden of tobacco-related disease.
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To evaluate the efficacy of nerve stimulation as an adjunct to ultrasound-guided supraclavicular nerve blocks. ⋯ For adequately imaged ultrasound-guided supraclavicular nerve blocks, a positive motor response to nerve stimulation does not increase the success rate of the block. In addition, the high false-negative rate suggests that these blocks are usually effective, even in the absence of a motor response. Nerve stimulation as an adjunct to ultrasound guidance may have a limited role.