Journal of clinical anesthesia
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Central venous cannulation, with or without a flow-directed pulmonary artery catheter, is commonly performed in patients undergoing cardiac surgery to measure central filling pressure and cardiac output, and to administer medications and fluids. The complications of central venous cannulation are numerous and include malposition, arterial puncture, pneumothorax, hemothorax, chylothorax, extravasation of infusate, thrombophlebitis, and infection. We describe a single-lumen catheter that was placed through the hemostatic valve of a 9F percutaneous introducer, which inadvertently entered the left internal mammary (internal thoracic) vein. The current case is unique in that it was diagnosed by visualization of the catheter during surgical dissection.
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To determine which patient parameters best predict left bronchial width (LBW) when selecting the correct size double-lumen tube (DLT). If LBW is known, a DLT that will fit that bronchus can be chosen. ⋯ Direct airway measurement is the most accurate way to select an appropriate DLT. However, when direct measurement of LBW cannot be performed, estimating LBW from TW is a better predictor of LBW than either sex, height, or weight.
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A 43-year-old man with neurofibromatosis and tracheal neurofibroma of the mid-trachea and respiratory difficulty was brought to the operating room for tracheostomy. After talking to the surgeons and viewing the computerized axial tomography, tracheal intubation was done under local anesthesia. Then, general anesthesia was provided for biopsy and debulking of the tumor, followed by tracheostomy. The patient had a number of surgeries later and the trachea was decannulated.
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Review Case Reports
Delayed pneumomediastinum and pneumothorax complicating laparoscopic extraperitoneal inguinal hernia repair.
A 53-year-old healthy man underwent elective laparoscopic, extraperitoneal, right-sided herniorrhaphy. Postoperatively, he complained of chest pain on inspiration. Chest x-ray and computed tomographic scan revealed a pneumomediastinum and a right-sided pneumothorax. Previous case reports and possible etiologies are reviewed.