Minerva anestesiologica
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Minerva anestesiologica · May 2012
Case ReportsComplete neurological recovery after systemic air embolism during endoscopic retrograde cholangiopancreatography.
Systemic air embolisms are a rare but often a fatal complication of endoscopic retrograde cholangiopancreatography (ERCP). Only few cases have been reported in scientific studies. This paper concerns a case of a systemic air embolism that occurred during endoscopic sphincterotomy for gallstone removal in a 79-year-old-woman and discusses possible mechanisms. ⋯ Supportive measures were initiated: she was administered 100% oxygen, she was placed head down, left lateral position and fluid resuscitation was started to increase venous pressure. We considered hyperbaric oxygen therapy for neurological injury but, despite the severe initial presentation, she had a complete clinical recovery with only conservative treatment. Present experience stresses the importance of the awareness of this uncommon complication: a close vigilance of the anesthetists during ERCP is critical to ensure early diagnosis and a timely intervention.
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From a medical point of view, aging is characterized by a potential failure to maintain homeostasis under conditions of physiological stress. This failure is associated with an increase in vulnerability. Physiological changes associated with aging are progressive but concomitant injury or diseases may rapidly worsen the health status of the patient. ⋯ Concerning postoperative comfort and neurological complications, age is the highest risk factor for developing dementia. Pain is underassessed and undermanaged. The elderly are at higher risk of adverse consequences from unrelieved or undertreated pain.
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Minerva anestesiologica · May 2012
Case ReportsSuccessful pre-emptive emergency management of a compromised airway with a Proseal™ Laryngeal Mask Airway followed by tracheostomy.
Following hemi-glossectomy and right neck dissection a 63-year-old female patient presented as an emergency with a large neck hematoma. There were significant concerns over difficulty in intubation and mask ventilation leading to deterioration into a cannot intubate cannot ventilate (CICV) situation. After careful discussion and planning with the surgical team, who planned a tracheostomy, the situation was salvaged using a ProSealTM Laryngeal Mask Airway (PLMA). The PLMA enabled rapid establishment of a clear airway early in anesthetic induction, controlled ventilation and safe airway maintenance during a difficult tracheostomy.