AANA journal
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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.
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Dexmedetomidine was used as an adjunct anesthetic for an infant with tetralogy of Fallot (TOF). who underwent complete surgical repair during a mission trip in Jamaica. Anesthetic maintenance was achieved with the concomitant use of dexmedetomidine and remifentanil infusions, as well as inhalational sevoflurane. The dexmedetomidine infusion ranged from 0.3 to 0.5 µg/kg/h and the remifentanil infusion ranged from 0.5 to 2 µg/kg/min, with end-tidal sevoflurane ranging from 0.8% to 6%. ⋯ This report includes a review of the anatomy and pathophysiology of tetralogy of Fallot, medical and surgical treatments, anesthetic management, as well as global health issues involved in caring for complex cardiac patients in this underserved population. The expertise and dedication of medical mission professionals ensures that children in developing Caribbean countries receive life-saving heart surgery that would otherwise not be available. Collaboration between pediatric cardiac surgery programs in the United States and developing programs in the Caribbean is vital to the future of a self-sustaining cardiac program that will provide the knowledge and resources to care for these complex cardiac patients.
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Randomized Controlled Trial Comparative Study
Comparison of fascia iliaca compartment block and 3-in-1 block in adults undergoing knee arthroscopy and meniscal repair.
Peripheral nerve blocks have become a popular method for treatment of pain after lower-extremity surgical procedures. Two peripheral nerve blocks for knee arthroscopy include the 3-in-1 block and the fascia iliaca compartment block (FICB). There is limited research comparing the efficacy of these blocks in adults undergoing knee arthroscopy and meniscal repair who receive both the peripheral nerve block and general anesthesia. ⋯ Patient satisfaction scores were similar between groups. Based on this study we recommend that the choice of block can be determined by the clinical scenario. We recommend a 3-in-1 block if speed of onset is the primary goal of anesthesia before induction, and we recommend the FICB block if prolonged postoperative analgesia is the primary goal.