Der Anaesthesist
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Case Reports
Awake craniotomy in a super obese patient using high flow nasal cannula oxygen therapy (HFNC).
Super obesity with a body mass index (BMI) >50 kg/m2 presents a challenge for the neuroanesthesiologist during awake craniotomy procedures and poses increased perioperative risk of complications, even vis-à-vis morbid obesity. This article presents a super obese patient (BMI 57 kg/m2) with drug-refractory epilepsy and obstructive sleep apnea who underwent left anterior temporal lobectomy through awake craniotomy to preserve language and memory, using warmed humidified high flow nasal cannula (HFNC) oxygen therapy. Awake craniotomy was facilitated by the use of HFNC, which proved essential to prevent airway collapse by creating continuous positive airway pressure through high flow and facilitated intraoperative neurologic language and memory testing while maintaining adequate oxygenation.
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Postoperative residual neuromuscular block (train of four ratio <0.9) is an outcome-relevant problem in balanced anesthesia, which increases postoperative morbidity and mortality. Implementation of medium and short-acting muscle relaxants, quantitative neuromuscular monitoring and pharmacological reversal of muscle relaxation reduce the incidence of residual neuromuscular block. The question arises whether this is suitable to create a pragmatic algorithm integrating these three individual methods to reduce paralysis-associated complications? ⋯ The algorithm-based concept of quantitative neuromuscular monitoring and pharmacological reversal using neostigmine and sugammadex enables residual neuromuscular block to be treated within 10 min before extubation of the patient. Ongoing educational programs are essential for implementation of modern muscle relaxant management concepts. Quantitative neuromuscular monitoring should be mandatory for all patients receiving neuromuscular blocking drugs. It would be desirable that German-speaking societies for anesthesiology make appropriate recommendations in guidelines.
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Case Reports
Tracheoesophageal fistula following button battery ingestion in an infant : Airway management considerations.
A 13-month-old infant was admitted to hospital approximately 3 weeks after ingestion of a button battery, which was lodged in the esophagus and had caused a tracheoesophageal fistula requiring mechanical ventilation. Since the battery had partially penetrated into the tracheal lumen just above the carina and also was in direct contact with the pulmonary artery, extensive considerations regarding airway and circulatory management were required preoperatively, which are presented and discussed in this case report.