Journal of clinical anesthesia
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We report the general anesthetic events and clinical concerns encountered with a laparoscopic cholecystectomy in a 19-month-old toddler. Carbon dioxide was insufflated to create a pneumoperitoneum, with resulting intra-abdominal pressures ranging from 5 to 11 mmHg. The end-tidal partial pressure of carbon dioxide (PETCO2) rose as high as 48 mmHg (a 10 mmHg increase from baseline), requiring a 68% increase in minute ventilation to achieve preinsufflation values. Careful monitoring of ventilation, PETCO2, and intra-abdominal pressure are recommended for optimal anesthetic management of the pediatric laparoscopic cholecystectomy patient.
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Case Reports
Use of the Augustine stylet anticipating difficult tracheal intubation in Treacher-Collins syndrome.
Treacher-Collins syndrome is a familial and congenital condition often associated with a difficult airway. Although the condition is rare, the anesthesia care provider may encounter it on occasion. ⋯ A nasotracheal intubation using the stylet component of a recently introduced airway device, the Augustine Guide, was successfully performed. This is believed to be the first reported use of this method using the Augustine stylet.