Journal of clinical anesthesia
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Case Reports
An atypical presentation of chronic Stanford type A aortic dissection during pregnancy.
Aortic dissection is a rare but devastating disease during pregnancy, usually presenting with sharp pains on the chest or back. We report a pregnant woman suffering from chronic Stanford type A aortic dissection presented with atypical symptoms without pain in the third trimester with markedly dilated aortic root and congestive heart failure, who received concomitant cesarean delivery and aortic repair with good maternal and fetal outcomes. Multidisciplinary approach and tight hemodynamic control are very important. More attention should be paid to those atypical symptoms so as to early identify this scarce but disastrous disease during pregnancy.
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Case Reports
Reversal of profound neuromuscular blockade with sugammadex in an infant after bronchial foreign body removal.
Sugammadex is a selective chemical agent that can reverse neuromuscular blockade induced by vecuronium and rocuronium. The aim of this report is to discuss the effectiveness of sugammadex in the reversal of neuromuscular blockade in children younger than 2 years. A 16-month-old boy, weighing 10 kg, was admitted to the pediatric emergency department due to choking, cyanosis, and severe respiratory distress that occurred while he was eating peanuts. ⋯ Clinical use of sugammadex in children younger than 2 years is not recommended because of the lack of clinical studies. In this case report, the profound neuromuscular blockade was successfully reversed with a dose of 2 mg/kg sugammadex in a 16-month-old boy. However, more prospective clinical studies are required for the safe use of this agent in children.
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More than 60 years have passed since 3 pioneer Chinese anesthesiologists were trained by American physicians. After returning to China, they applied their new knowledge and skills to develop a new anesthesia specialty in their own country. Over the past 2 decades, close to 600 Chinese medical graduates have been trained in the United States and have become part of the American anesthesia workforce. ⋯ People are always wondering how this new generation of American-trained Chinese anesthesiologists is doing in a different culture and different health care and political systems. This review indicates that these newly American-trained Chinese anesthesiologists not only provide high-quality patient care but also conduct outstanding anesthesia teaching and research. In addition, as their pioneer anesthesiologists did in China, they use professional organizations and publications as 2 major means to advance professional development and promote academic exchanges between Chinese and American anesthesiologists, through which American anesthesiology continues to have influence on modern Chinese anesthesiology.
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Characterize the incidence of elevated aPTT results in patients treated with prophylactic, subcutaneous unfractionated heparin (UFH). ⋯ Treatment with UFH resulted in a small, but significant, increase in aPTT.
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Use lean methodology to create a more efficient difficult airway management equipment transport and setup. ⋯ Application of this lean method resulted in a revised single cart with equipment pared down to only what is needed, arranged according to frequency and order of use in a difficult airway. In a simulated difficult airway, there was a reduction in non-value-added time and walking distance to retrieve the equipment.