AANA journal
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Morbid obesity is a relatively common and vastly increasing condition that can have a profound impact on morbidity and mortality during the administration and maintenance of general and regional anesthesia. Physiological derangements, difficult airway management, and biological augmentation in pharmacokinetics are some of the clinical challenges involved with this particular patient population. This case report discusses the advantages of regional versus general anesthesia in the morbidly obese patient population, in conjunction with an analysis of the various types of spinal anesthetics. This will be followed by a focused discussion related to the management of a morbidly obese patient undergoing a nonelective orthopedic procedure.
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Randomized Controlled Trial Comparative Study
Ease of intubation with the Parker Flex-Tip or a standard Mallinckrodt endotracheal tube using a video laryngoscope (GlideScope).
Two endotracheal tubes (ETTs) are available for use in operative suites for intubation: the Parker Flex-Tip (PFT, Parker Medical) and the standard Mallinckrodt (Covidien). To the authors' knowledge, no study has compared these 2 ETTs with each other when the anesthesia provider uses the GlideScope video laryngoscope (Verathon) for intubation. The purpose of the study was to determine if there are differences related to ease of intubation reported by anesthesia providers who use the PFT tube compared with the standard tube while using the GlideScope. ⋯ The PFT tube in suboptimal conditions demonstrated a significantly greater ease of intubation, as measured by decreased time for ETT insertion and greater ease of ETT insertion score. The number of redirections at the glottis to intubate the trachea once the glottis was visualized was not statistically different. Based on the findings from this study, anesthesia providers may want to consider the use of the PFT tube when using the GlideScope to promote ease of intubation.
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Obstructive sleep apnea (OSA) is a chronic disease that is underdiagnosed. It is characterized by repetitive pauses in breathing during sleep that can last for several seconds and can subsequently cause hypoxia-related complications. This apnea can lead to significant medical problems, daytime somnolence, cognitive impairment, decreased work productivity, and an increased risk of motor vehicle crashes. ⋯ If patients who have OSA or who are at risk for having OSA are identified before surgery, anesthesia providers can take action to prevent perioperative complications. Guidelines published by the American Society of Anesthesiologists provide helpful anesthetic considerations for patients with OSA undergoing surgery in an effort to decrease morbidity and mortality. While research into the effects of surgery and anesthesia in patients affected by OSA is ongoing, compliance with these recommendations, along with vigilance, will help ensure that many patients with OSA can be managed safely during their surgical experiences.
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Case Reports
Awake video laryngoscope intubation: case report of a patient with a nasopharyngeal mass.
Difficult airway management remains central to anesthesia practice. Video laryngoscopes have been an adjunct to airway management since the early 2000s. ⋯ The purpose of this article is to summarize the use of a video laryngoscope for an awake intubation and to suggest alternative uses of these devices in other awake intubation scenarios. The case report presented offers a description of successful awake intubation using a video laryngoscope in a patient with a large pedunculated mass arising from the nasopharynx and extending down into the oropharynx.