AANA journal
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This case report describes the use of sevoflurane in a 26-year-old woman who presented to a rural critical access hospital emergency department in status asthmaticus and subsequently failed conventional therapy. Although the use of potent inhalation agents in the treatment of refractory status asthmaticus has been documented, there is little written about the use of sevoflurane in this situation. Sevoflurane was administered for approximately 2(1/2) hours, stabilizing the patient's condition enough to allow fixed-wing air transport to a tertiary facility.
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Review Case Reports
Use of the LMA classic to secure the airway of a premature neonate with Smith-Lemli-Opitz syndrome: a case report.
In addition to managing the most challenging of airways within the operating room environment, anesthesia providers are frequently consulted or requested to participate in emergency airway control in various areas of the hospital, often after other providers have failed. The following is a case report of a premature infant born with multiple and life threatening congenital anomalies in a rural facility. The current recommendations of the American Heart Association for neonatal resuscitation were followed; however, the resuscitating team was unable to secure the airway using standard intubating techniques. ⋯ The pediatrician involved in the care of the patient had minimal experience with using the LMA; however, with verbal instruction was able to successfully place the LMA. With a patent airway established, the patient stabilized and was transferred to a tertiary facility for aggressive care. Although currently not part of the American Heart Association neonatal resuscitation algorithm, consideration of the LMA as a tool to manage an airway after failed attempts at intubation may be appropriate.
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Review Case Reports
Ruptured arteriovenous malformation and subarachnoid hemorrhage during emergent cesarean delivery: a case report.
Cerebral arteriovenous malformations (AVMs) are formed from a vascular plexus of direct arterial-venous connections that progressively dilate, making them prone to rupture. They are frequently asymptomatic and often remain undiagnosed until they present with associated symptoms of headaches, seizures, neurological deficits, or hemorrhages. Occurrence of headache during pregnancy and labor is associated with several diverse etiologies, making definitive diagnosis extremely difficult. This case report describes the anesthetic management of a 31-year-old laboring patient who first complained of headache, then suffered an acute subarachnoid hemorrhage secondary to rupture of a previously undiagnosed AVM during emergent cesarean delivery.
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Advanced airway practitioners in anesthesiology, emergency medicine, and prehospital care can suddenly and unexpectedly face difficult airway situations that can surface without warning during mask ventilation or tracheal intubation. Although tracheal intubation remains the "gold standard" in airway management, it is not always achievable, and, when it proves impossible, appropriate alternative interventions must be used rapidly to avoid serious morbidity or mortality. The SLAM Emergency Airway Flowchart (SEAF) is intended to prevent the 3 reported primary causes of adverse respiratory events (ie, inadequate ventilation, undetected esophageal intubation, and difficult intubation). ⋯ It is intended for use with adult patients by advanced airway practitioners competent in direct laryngoscopy, tracheal intubation, administration of airway drugs, rescue ventilation, and cricothyrotomy. The SEAF has limitations (eg, suitable only for use with adult patients, cannot be used by certain categories of rescue personnel, and depends heavily on assessment of Spo2). A unique benefit is provision of simple alternative techniques that can be used when another technique fails.