Journal of clinical anesthesia
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We report the successful use of the Air-Q laryngeal airway (Air-Q LA) as a ventilatory device and a conduit for tracheal intubation to rescue the airway in a patient with difficult airway and tracheal stenosis. This is the first case report of the device to secure the airway after two episodes of hypoxemia in the operating room and intensive care unit. Consent for submission of this case report was obtained from our institution's human studies institutional review board given that the patient died a few months after his discharge from the hospital before his personal consent could be obtained and before preparation of this report. ⋯ On the sixth day of SICU admission, he underwent surgical tracheostomy and laser excision of a stenotic tracheal lesion, returned to the SICU, was weaned off mechanical ventilation, and discharged 2 weeks later to a rehabilitation center with stable ventilatory capabilities. This case demonstrates successful use of the Air-Q LA in the emergency loss of airway scenario as a ventilatory device and as a conduit for endotracheal intubation when fiberoptic bronchoscopy alone may be difficult and hazardous. This case suggests the need for further evaluation of the impact of the Air-Q LA on outcomes when used as a rescue device and conduit for tracheal intubation in patient with disease activity.
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Survivors of myocardial infarction might have residual damage and higher risks of developing heart failure. This increasing complication encompasses up to 45% of all infarcts. ⋯ To guide the surgeon during the intervention we used a real-time 3D echocardiography, enlightening the fact that guidance is crucial for that kind of procedure. To lower postoperative pain and the inflammatory response we have administered successfully intravenous lidocaine, indicating that it is possible to avoid regional anesthesia in patients with multiple sclerosis scheduled for mini-invasive left ventricular reconstruction requiring a mini-thoracotomy.
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Observational Study
Guideline-recommended 15° left lateral table tilt during cesarean section in regional anesthesia-practical aspects: An observational study.
Left lateral table tilt of 15° to 30° is recommended for cesarean section, although little is known about the practical problems of its implementation. This study examines these issues from the perspective of anesthesiologists, obstetricians, theater nurses, and patients. Initially, the tilt was set by visual estimation in 100 women and checked by inclinometer afterwards. ⋯ Implementation of 10° to 15° tilt requires objective inclinometry. It allows tilt adjustment to be made by interdisciplinary staff in greater confidence that patient comfort and surgical conditions will not be impaired. Strategies to reduce discomfort are presented in this article.
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Opioids cause spasm of the sphincter of Oddi. Remifentanil is metabolized enzymatically throughout the body. Its context-sensitive half-time is 3 to 4minutes. ⋯ The predicted plasma concentrations of remifentanil at the time of stopping its administration and at the time of disobliteration were 6.38and 2.55ng/mL, respectively. The patient's postoperative course was uneventful. In patients who have spasms of the sphincter of Oddi during the administration of remifentanil, the resultant obstruction can be treated effectively by reducing the infusion rate of remifentanil.
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Observational Study
Endotracheal tube displacement during head and neck movements. Observational clinical trial.
Measure the displacements of endotracheal tube (ETT) tip displacement during head and neck movements. ⋯ Maximal head and neck movements led to unpredictable tube displacements. Proper reassessment of tube positioning after head and neck movement of intubated patients is therefore mandatory.