Journal of clinical anesthesia
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Intubating laryngeal mask airways can be used to provide continuous ventilation throughout intubation. This is a case of a morbidly obese (body mass index = 58) 65-year-old woman with T10 and T11 compression fractures. Optimal positioning for airway management was hindered by her unstable spine, minimal neck range of motion, and extreme pain with any movement. An intubating laryngeal mask airway was placed in the awake, topically anesthetized patient, and the laryngeal mask airway and endotracheal tube combination was left in place throughout surgery.
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We investigated the prevalence of lifestyle risk factors in patients admitted to our preoperative assessment outpatient clinic, and compared patient self-reports and anesthetist reports of health risk factors to evaluate the patient self-image of preoperative health status. ⋯ The prevalence of lifestyle risk factors in perioperative patients is high, and differences in reporting between patients and anesthetists may suggest that patients are unaware of or ignore their unhealthy state. Further studies are warranted to investigate the association between the lifestyle risk factors and outcome in the anesthesiology setting.
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Observational Study
Can the choice of the local anesthetic have an impact on ambulatory surgery perioperative costs? Chloroprocaine for popliteal block in outpatient foot surgery.
Short-acting regional anesthetics have already been successfully used for peripheral nerve blocks in an ambulatory surgery setting. However, the impact on direct and indirect perioperative costs comparing 2 different short-acting local anesthetics has not been performed yet. ⋯ We conclude that the more expensive chloroprocaine 3% for ambulatory foot surgery can reduce total perioperative costs and reduce length of stay in outpatient patients. Moreover, the saved time and personal resources could be used for additional cases, further increasing the revenues of an ambulatory surgical center.
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Case Reports
A case of scrotal pain associated with genitofemoral nerve injury following cystectomy.
The genitofemoral neuropathy is one of the most common causes of groin pain after surgery. Especially, the groin pain induced by genitofemoral nerve injury during herniorrhaphy is a well-known complication. In contrast, much attention is not paid for groin pain induced by genitofemoral nerve injury after pelvic surgery, and there have been few reports in males, although it has been reported in females. ⋯ He had severe allodynia of the ventral scrotum and bilateral ventromedial thigh region, with absence of cremasteric reflex. We speculated that his pain might have been surgery-induced genitofemoral neuropathy, which was caused by nerve injury during lymphadenectomy near the external iliac vessels. His scrotal pain and allodynia following the cystectomy were partially and gradually relieved after administering pregabalin, further supporting the contention that his scrotal pain was a surgery-induced neuropathy.
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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.