ICU management of the obstetric patient
Publication date: Available online 15 February 2020Source: Trends in Anaesthesia and Critical CareAuthor(s): Sima Patel, Andrea Estevez, Nicholas Nedeff, Jose Gascon, Ilde LeeAbstractAcross the United States (U.S.), very few centers exist with an intensive care unit (ICU) solely dedicated to obstetrics (OB) and gynecology (GYN) patients. The management of obstetric patients, who are admitted to a general intensive care unit, can often be accompanied by a fair share of apprehension owing to the intricacy of care. Rather than discussing common obstetric emergencies and their management, we would like to call attention to basic principles that are fundamental in the care of a complicated OB intensive care patient. Understanding the physiologic changes of each trimester and the layers of management is imperative. Having a strong, fundamental knowledge of the plethora of medications and their safety profiles will ensure optimal patient care and dissolve the uncertainty surrounding this unique patient population. What follows is a literature review on sedation, analgesia, airway management, mechanical ventilation and cardiovascular support for critically ill obstetric patients.
Publication date: Available online 7 October 2020Source: Trends in Anaesthesia and Critical CareAuthor(s): Soumya Sarkar, Anudeep Jafra, Preethy Mathew
ConclusionsIn this mannequin-based simulation study, the use of the aerosol box increased the time to intubation in some contexts but not others. Further studies in a clinical setting should be conducted to make appropriate modifications to the aerosol box to fully elicit its efficacy and safety prior to implementation in airway guidelines for managing patients with COVID-19.
LUNG TRANSPLANTATION, either single or bilateral, involves recipient pneumonectomy followed by implantation and reperfusion of the donor lung. Contemporary approaches to lung transplantation require lung isolation to assist recipient pneumonectomy and donor lung implantation.1 Single-lung transplantation requires interruption of ventilation to the side of allograft transplantation, whereas bilateral lung transplantation involves sequential one-lung ventilation (OLV) when performed without mechanical circulatory support.
Publication date: Available online 5 October 2020Source: Advances in AnesthesiaAuthor(s): Thomas E. Grissom, Ron E. Samet
We describe a case of difficult airway management in a patient with massive cervical hydatid cyst. We used a low-dose ketamine-propofol sedation and lidocaine spray for local oropharyngeal anesthesia. Muscular relaxants were not used, and spontaneous breathing was maintained during intubation. Recognition, assessment, and perioperative planning are essential for difficult airway management in patients with cervical hydatid cyst. PMID: 33004207 [PubMed - as supplied by publisher]
This article describes how an anesthesiology department at a large urban academic hospital rapidly adapted and deployed to meet the threat head-on. Topics included are preparatory efforts, devel opment of a team-based staffing model, and a new strategy for resource management. While still maintaining a fully functioning operating theater, discrete teams were deployed to both COVID-19 and non-COVID-19 intensive care units, rapid response/airway management team, the difficult airway response team, and labor and delivery. Additional topics include the creation of a temporary ‘pop-up’ anesthesiology-run COVID-19 in...
In this report, we describe a scenario of neonate with multiple oral teratoma, cleft palate, and bifid tongue who presented with respiratory distress for surgical excision of mass. The compromised airway can be successfully managed by appropriate prior planning and effective communication between anesthesiologist and surgical team.
AbstractPurpose of ReviewSignificant morbidity is caused by hypoxemic events during procedural sedation, induction for tracheal intubation, and postoperatively after anesthesia in the postoperative care unit. Novel and advanced oxygenation techniques will be discussed to help prevent hypoxemia and improve patient outcome.Recent FindingsASA closed claims outside the operating room showed an increase in oxygen desaturation during moderate to deep sedation with no or conventional oxygenation. Non-invasive positive pressure oxygenation (NPPO) reduces the incidence of oxygen desaturation during procedural sedation, during induc...
Farah Nasreen, Mohit Prakash, Atif Khalid, Danish HushainIndian Journal of Anaesthesia 2020 64(16):245-247 Presence of intraoral pathology especially in neonates poses a great challenge during airway management. Epignathus is a rare form of teratoid tumour that arises from the oropharyngeal region. We hereby report a case of a 7-day-old neonate who presented with feeding difficulty secondary to swelling arising from the hard palate. Surgical excision was decided to overcome feeding difficulty and to enable the child to thrive better. In view of anticipated difficult airway, the child was induced with sevoflurane, maintain...