A & A case reports
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This case report illustrates the importance of proper assessment, management, and creation of an emergent surgical airway. Assessment after the establishment of surgical airways should include confirmation of correct surgical site and appropriate location and depth of tracheostomy, tracheal tube, or catheter placement within the trachea. Supraglottic surgical airway access, as occurred in this case, can lead to laryngotracheal and esophageal injury. Early recognition and appropriate management of this complication can increase the likelihood of preservation of voice and airway function and minimize the extent of esophageal injury.
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A 20-year-old female underwent orthotopic liver transplantation for arginase deficiency, a urea cycle disorder. A hyperammonemic state was prevented by the administration of lipid and carbohydrate substrate and avoidance of protein loading (including human albumin) and prolonged fasting. Caval cross-clamping may have been tolerated poorly owing to the potential interaction between hyperargininemia (a nitric oxide precursor) and the lack of collateral venous drainage. Ammonia and arginine levels improved in parallel with hepatic function after reperfusion of the hepatic graft.
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A 44-year-old man undergoing ambulatory surgery sustained a 5% total body surface first-degree burn on his lower and lateral torso and upper thigh during routine use of a new forced-air warming Bair Paws™ flex gown system. We describe the likely mechanism of injury, intraoperative events suggesting special variation in the warming process, and a brief review of adverse events associated with forced-air warming systems.