AANA journal
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Airway catastrophes have been identified as the leading cause of injury and death during anesthesia. Proper management of a patient with a technically difficult airway commences with problem recognition. Physical limitations to mask ventilation and endotracheal intubation may be accurately identified by thorough observation. ⋯ Prudent options may include awakening the patient, proceeding with mask ventilation, or performing semi-elective tracheostomy. Emergency airway access may be achieved with a tracheoesophageal airway, esophageal tracheal combitube, laryngeal mask airway, digital intubation, or obtained surgically by transtracheal jet ventilation or tracheostomy. Reduction of airway-related morbidity and mortality is best achieved with an understanding of airway anatomy, common causes and prompt recognition of compromise, and alternative techniques of establishing patency and ventilation.
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Case Reports
A case report: the use of ketamine and midazolam intravenous sedation for a child undergoing radiotherapy.
The combination of ketamine hydrochloride and midazolam was used to successfully provide intravenous sedation for a child requiring daily radiation treatments. During the radiation therapy treatments, the anesthesia provider was not in direct contact with the patient. Traditional monitoring was complemented by the addition of closed-circuit television monitoring. The drug combination provided consistent cardiac and respiratory stability, as well as patient immobility, for each radiation treatment.