Minerva anestesiologica
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Minerva anestesiologica · Aug 2010
Case ReportsUltrasound-guided interscalene catheters performed under general anesthesia in a patient with Huntington's disease.
The placement of interscalene nerve blocks in adults under general anesthesia remains controversial. There have been reports of patients who suffered permanent losses of cervical spinal cord function during this practice; however, these cases employed long needles and paresthesia or nerve stimulator techniques with high stimulation currents. As a result, practitioners currently use short needles for interscalene block and value feedback from patients who are awake. ⋯ Ultrasound permits direct visualization of the needle, nerves, and local anesthetic spread and may decrease the risk of catastrophic complications. As in children, in whom awake placement is extremely difficult or even impossible, certain adult patient populations may only be offered the advantages of a peripheral nerve catheter if it is placed after the induction of general anesthesia. We report the case of a patient with Huntington's disease who was only able to undergo a total shoulder arthroplasty following ultrasound-guided placement of a continuous interscalene block under general anesthesia.
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Minerva anestesiologica · Aug 2010
Tracheal intubation using the mobile C-MAC video laryngoscope or direct laryngoscopy for patients with a simulated difficult airway.
Several studies have shown that video laryngoscopy enhances the laryngeal view in patients with apparently normal and anticipated difficult airways. The utility of the novel, portable, battery-powered C-MAC video laryngoscope is unproven, but its design makes it potentially useful for emergency situations. We hypothesized that, in patients with a simulated difficult airway created by means of a rigid cervical immobilization collar, the rate of glottic views considered "failed" under direct laryngoscopy could be significantly reduced with the C-MAC video laryngoscope. ⋯ The C-MAC video laryngoscope effectively enhanced the laryngeal view in patients with limited inter-incisor distance and eliminated cervical spine clearance. However, endotracheal tube placement failed in 5/43 patients despite a mostly good laryngeal view.
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Minerva anestesiologica · Aug 2010
Editorial CommentVideolaryngoscopy: is it only a change of view?