A & A case reports
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A 3-year-old boy underwent tracheostomy at age 5 months for respiratory failure. The tracheostomy tube was removed a year later but a tracheocutaneous fistula developed requiring fistulectomy and primary skin closure. ⋯ Orotracheal intubation was emergently performed and chest radiograph revealed pneumothorax and pneumomediastinum. The child was taken to the operating room for placement of a tracheostomy tube.
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Emergence delirium (ED) in adult patients encountered in the postanesthesia care unit (PACU) is not well studied; nor are ED treatment strategies. Similar to delirium in the intensive care unit, ED in the PACU can result in serious complications. ⋯ Although likely utilized more frequently in recent years, the use of dexmedetomidine in the PACU for treatment of ED is not established in the literature. Further research regarding treatment of ED in adults is necessary, allowing for optimization of patient care and improvement in patient outcomes.
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An elderly male presented for emergent repair of a ruptured abdominal aortic aneurysm. For anticipated volume resuscitation, vasopressor administration, and hemodynamic monitoring, a large-bore central venous catheter was placed in the left internal jugular vein under ultrasound guidance before surgical incision. ⋯ However, a massive left hemothorax developed because of perforation of the brachiocephalic vein and violation of the pleural space. This case report discusses both prevention and management of such a complication.
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We report the case of a 37-year-old female patient who required 22 surgeries following a pedestrian versus car accident. She was enrolled in a clinical study investigating emergence from anesthesia. ⋯ We observed PACU delirium in all 4 cases in which the patient received sevoflurane, but only in 1 of 6 cases in which she received propofol. The patient showed EEG α-band activity similar to that of an elderly patient who may reflect a greater risk of PACU delirium.
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Ultrasound-guided regional anesthesia requires the anesthesia provider to interpret new information. This article reports on the case of a 38-year-old man scheduled for a fifth metacarpal fracture repair. ⋯ Regional anesthesia was abandoned in favor of general anesthesia. Ultrasonography training needs to be expanded in the coming years to include awareness of the abnormal pathology, as it might impact the choice of anesthetic procedure and patient outcome.