AANA journal
-
Review Case Reports
Unilateral hypoglossal neurapraxia following endotracheal intubation for total shoulder arthroplasty.
A case is described of postoperative right hypoglossal neurapraxia after general anesthesia and interscalene block with endotracheal intubation for left total shoulder arthroplasty. Postoperative hypoglossal neurapraxia has been reported in cases, yet it remains a rare complication of anesthesia-related interventions. ⋯ Anesthesia providers should be aware of the course of cranial nerve XII as it relates to the position of the head and neck and use of airway instrumentation. In suspected cases of hypoglossal neurapraxia, conservative therapeutic interventions may be warranted.
-
Review Case Reports
Preoperative chlorhexidine anaphylaxis in a patient scheduled for coronary artery bypass graft: a case report.
Chlorhexidine is a synthetic antiseptic and disinfectant that has been widely used in the healthcare setting and in everyday household products. In addition to oral rinses and skin preparations, manufacturers have incorporated chlorhexidine coatings into medical devices such as urinary catheters, endotracheal tubes, and central venous catheters in an effort to reduce infection rates. Despite the ubiquitous use of chlorhexidine, severe reactions, such as anaphylaxis, are relatively rare. ⋯ To our knowledge, this is the first reported perioperative anaphylactic reaction to chlorhexidine in the United States. A review of the anaphylaxis cascade, the prevalence of hospital-acquired infections, and the risks of using chlorhexidine are thoroughly discussed. It must be appreciated that life-threatening reactions to this commonly used agent are more than just a theoretical possibility.
-
General anesthesia is known to cause pulmonary atelectasis; in turn, atelectasis increases shunt, decreases compliance, and may lead to perioperative hypoxemia. One mechanism for the formation of atelectasis intraoperatively is ventilation with 100% oxygen. The goal of this review is to determine if research suggests that intraoperative ventilation with 100% oxygen leads to clinically significant pulmonary side effects. ⋯ From this body of research, it appears that absorption atelectasis does occur in healthy anesthetized adults breathing 100% oxygen. Data reviewed suggest that absorption atelectasis does not have significant clinical implications in healthy adults. However, further research is warranted in populations at increased risk of postoperative hypoxemia, including obese or elderly patients and those with preexisting cardiopulmonary disease.
-
This course explores the considerations that the anesthesia provider has to be aware of, when caring for a patient with a mitochondrial myopathy. Even though these disorders are rare, these patients may also need surgical care, requiring that the anesthesia provider be informed of the best anesthesia options to consider. A narrative review of documented cases and their outcomes is used to generate a resource of current opinions in the anesthetic care of this patient population.
-
Emergence agitation or delirium is a known phenomenon in the postanesthesia period. The underlying cause is not definitively understood. In a U. ⋯ The authors conclude that best practice includes a proper identification of patients at risk of emergence agitation, a minimally stimulating environment, intraoperative sympatholytic therapy, and patient and staff education. Although the case studies presented support these principles, research is needed to provide stronger evidence. Military medical and research personnel can take the lead on this issue and be a source for improved outcomes and high-quality patient care.