BMC anesthesiology
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The neural integrity monitor (NIM) electromyogram (EMG) endotracheal (ET) tube is a widely used device to monitor neural response through muscle activity. It is helpful in surgical procedures with high risk of damaging delicate structures in the head and neck. This case provides a thorough analysis of an adverse event that was encountered in the operating room, which others can hopefully learn from. ⋯ There are several similar reports of these endotracheal tubes causing obstruction, especially those in which overinflation of the cuff caused cuff herniation and blockage of the Murphy eye and the bevel. It is currently believed that the design of this tube allowed for the obstruction to occur. The patient's short body habitus may have also been a small contributing factor. The distance that the electrodes must sit within the vocal cords to the tip of the bevel is longer in this type of ET tube compared with a standard ET tube. The distance from the true vocal cords to where the cuff sits in the trachea is also greater in this model NIM EMG tube. There was no confirmation of the exact obstructive process that took place, however, confirming the tube and cuff positioning would have been optimal.
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Methods for improving the safety of medical treatments for patients, reducing the occurrence of postoperative complications and optimizing medical resources for primary hip replacement are needed. Previous literature has mostly analysed the risk factors and constructed and models to predict a transfer to the ICU after surgery, and no reports on preoperative ICU reservations have been found. This study evaluated the risk factors for preoperative ICU reservation and considered the necessity of preoperative ICU reservations to optimize preoperative communication, enable a seamless transfer between the operating room and ICU, reduce postoperative complications and shorten hospital stays. ⋯ For patients requiring primary hip replacement. Age, general anesthesia, preoperative C-reactive protein, preoperative alanine aminotransferase and preoperative albumin are the key points of our preoperative assessment. Paying attention to the changes of these indicators will help surgeons assess the patient's condition and contact the ICU in advance.These data can be fully understood by the patients' families, reduce the unnecessary use of medical resources, and optimize perioperative management.
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Reintubation is a severe complication during foreign body (FB) removal that uses flexible bronchoscopy. ⋯ Children undergoing FB removal by a flexible bronchoscopy may encounter with a high incidence of postoperative reintubations. Both long operative duration and a severe physical status cause a growing risk of reintubations.
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To examine factors associated with post-Cesarean section analgesic prescription variation at hospital discharge in patients who are opioid naïve; and examine relationships between pre-Cesarean section patient and care-level factors and discharge morphine equivalent dose (MED) on outcomes (e.g., probability of opioid refill within 30 days) across a large healthcare system. ⋯ Significant variation in discharge pain medication prescriptions, as well as the lack of association between discharge opioid MED and probability of refill, indicates that efforts are needed to optimize opioid prescribing and reduce unnecessary healthcare variation.
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To compare the effectiveness of intraoperative cell salvage (IOCS) combined with a modified leucocyte depletion filter (MLDF) with IOCS combined with a regular leucocyte depletion filter (RLDF) in eliminating tumour cells from blood salvage during metastatic spine tumour surgery (MSTS). ⋯ Tumour cells could be removed by IOCS combined with RLDF from blood salvaged during MSTS, but residual tumour cells remained. The findings support the notion that MLDF eliminates tumour cells more effectively than RLDF. Hence, this technique can be applied to MSTS.