A & A case reports
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Central venous catheterization is widely used in patients on hemodialysis. A rare complication associated with the clinical use of central venous catheters is perforation of the heart or major vessels. We report a case of inadvertent perforation of the left atrium and thrombosis after the placement of a hemodialysis catheter in the right internal jugular vein. In such cases, surgical removal of the central venous catheter from perforation sites in the heart and vessel walls poses anesthetic challenges because of the high risk of pneumothorax, hemorrhage, arrhythmias, thrombosis, and death.
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Currently, perioperative health care is undergoing transformative changes. One prospect for the specialty of anesthesiology is a reorientation of resident education to focus more on the entire spectrum of perioperative care as exemplified by the perioperative surgical home (PSH). To advance this novel paradigm for patients and anesthesiologists, one must also consider further incorporating the competencies fundamental to the PSH during residency training. As such, the purpose of this case report is to outline the successful implementation of a comprehensive PSH curriculum for anesthesiology residents.
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Sevoflurane vaporizers (GE Tec 7) were difficult to fill with "slow flow" and a need to "burp." Evaluation of the bottle of sevoflurane (AbbVie Ultane) demonstrated a contaminant. Four of the facilities' 13 sevoflurane vaporizers had the contaminant. ⋯ Gas chromatography revealed the production of multiple metabolites of sevoflurane, including primarily urea and 1,3,5-triazine-2,4,6(1H,3H,5H)-trione (83% and 9.6% of volatiles) in addition to multiple other organic molecules. Sevoflurane contains water that can accumulate in vaporizers allowing bacterial growth.
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The safety of anesthesia was dramatically improved by the introduction of pulse oximetry. This technology was rapidly adopted by anesthesiologists and made a standard of practice in many countries. ⋯ The Lifebox Foundation was formed to determine how a suitable oximeter could be made available to anesthesia providers in these countries. Almost 11,000 oximeters have been delivered in 90 countries, with education courses completed in over 50 countries.