Emergency 3-Dimensional–Printed Devices for Splitting Ventilators in Lungs With Different Compliances: An In Vitro Study
Ventilator shortages occurred due to the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This in vitro study evaluated the effectiveness of 3-dimensional (3D)–printed splitters and 3D-printed air flow limiters (AFL) in delivering appropriate tidal volumes (TV) to lungs with different compliances. Groups were divided according to the size of the AFL: AFL-4 was a 4-mm device, AFL-5 a 5-mm device, AFL-6 a 6-mm device, and no limiter (control). A ventilator was split to supply TV to 2 artificial lungs with different compliances. The AFL improved TV distribution. (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Innovation Source Type: research
A Simple Tool for Recommending Postoperative Status After Lower Extremity Total Joint Replacement
There is an increasing impetus to perform primary total hip arthroplasty and total knee arthroplasty on an outpatient basis and in the outpatient setting. However, with recent federal regulatory changes, orthopedic surgeons must now evaluate patients on a case-by-case basis to determine whether an inpatient admission will be medically necessary and appropriate. We thus created our prototype Lower Extremity Inpatient-Outpatient (LET-IN-OUT) total joint replacement tool as a simple, consistent way for other clinicians to identify specific major preoperative patient comorbidities and thus to recommend independently and object...
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Innovation Source Type: research
The Answer to the Silent “Super Spreader”: An Innovative Way to Manage Chest Drains on Coronavirus Patients With Active Air Leaks
The risk of aerosol transmission has been a key factor for the rapid dissemination of the coronavirus pandemic. Transportation of coronavirus disease 2019 (COVID-19)–infected patients with active air leaks could expose unprotected health care personnel and other patients to aerosolized viral particles. We devised a way to avoid aerosolization while the chest tube drain is on water seal. It involves placing an Ultipor100 viral filter on the suction port of the drain system as well as sealing off the safety valve. This mechanism allows positive pressure from an air leak to escape while on water seal while trapping viral pa...
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Innovation Source Type: research
Closed Bronchoscopy System: An Innovative Approach to Minimize Aerosolization During Bronchoscopy
Health care workers performing aerosolizing procedures on patients with transmissible infections such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) are at high-risk for disease acquisition. Current guidelines designed to protect health care workers during aerosolizing procedures prioritize personal protective equipment and enhanced infection control techniques, in particular during procedures such as intubation. To date, little emphasis has been placed on risk mitigation in the setting of bronchoscopy, a procedure that has significant aerosolization potential. Herein, we present an innovative closed bronc...
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Innovation Source Type: research
Superficial Cervical Plexus Block for Awake Large-Bore Central Line Placement in Parturients: A Case Series
Pregnant patients with high-risk conditions including abnormal placentation or severe cardiovascular disease may require large-bore central venous access at the time of delivery. Central lines are generally inserted while obstetric patients are awake, either because neuraxial anesthesia is planned or to minimize fetal exposure to anesthetic medications. Despite local infiltration, the procedure can cause significant patient discomfort. This case series describes use of a superficial cervical plexus block (SCPB) to facilitate line placement in 4 pregnant women with high-risk conditions. SCPB is technically straightforward w...
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Case Series Source Type: research
A Consecutive Case Series of Rescue Intubations With the Articulating Total Control Introducer for Precision Tracheal Access
Effective rescue after failed intubation is important to limit the number of attempts and patient risk. Nothing is known about the Total Control Introducer’s (TCI) effectiveness as an intubation rescue device. A single system’s airway management database was studied. The TCI was used for rescue in 34 cases. Overall success was 33 of 34 (97%). First-pass success was 32 of 33 (97%). First-pass rescue was successful in 12 of 12 (100%) after video and direct laryngoscopy had failed. In this case series, the TCI was found to be a highly effective rescue technique after failed direct and video laryngoscopy. (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Case Series Source Type: research
Administration of Sugammadex Intraoperatively in a Patient With a Congenital Myasthenic Syndrome: A Case Report
We present the case of a 6-year-old boy with a congenital myasthenic syndrome who received sugammadex without complication. This case provides support for clinicians to consider sugammadex in these patients. (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Use of Continuous Glucose Monitoring to Facilitate Perioperative Glycemic Management: A Case Report
Perioperative glycemic management remains an important variable in a host of postoperative outcomes, including wound infection, reoperation, and death. Patients with diabetes mellitus are increasingly utilizing continuous glucose monitors to assist with glycemic management; the ability to harness the intensive monitoring capabilities of continuous glucose monitoring (CGM) technology perioperatively presents a promising opportunity to improve patient outcomes. Here, we assessed the accuracy of CGM compared to capillary point-of-care and arterial blood analysis in 2 cases where CGM was utilized as an adjunct method of periop...
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Paraganglioma Presenting as Hypoxia and Syncope in Pregnancy: A Case Report
Paragangliomas (PGLs) are rare tumors with an incidence of 0.007% in pregnant women. Patients with PGLs commonly present with hypertension and tachycardia. This case report describes the evaluation and management of a multiparous woman at 32 weeks of gestation with syncope, hypoxia, and tachycardia as unusual presenting symptoms of PGL. Her symptoms were attributable to paradoxical effects of circulating catecholamines on downregulated alpha-adrenergic receptors resulting in decreased systemic vascular resistance. (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Anesthesia for a Patient With Aicardi-Goutières Syndrome: A First Case Report
We describe our anesthetic management and discuss these implications. The patient had a prolonged duration of action of rocuronium and an otherwise uneventful anesthetic course. (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Peripartum Management in Myelodysplastic Syndrome Guided by Serial Thromboelastography: A Case Report
Myelodysplastic syndrome with severe thrombocytopenia is a rare disease in women of child-bearing age. The challenging aspect in management of such a patient is maintaining optimal coagulation with minimum platelet transfusion during the peripartum period. Multiple transfusions can result in allo-sensitization which can affect lifesaving bone marrow transplantation in future. Thromboelastography is a useful tool to assess and guide appropriate transfusion requirements. (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Intraoperative Management of a Child Undergoing Cardiac Surgery With Congenital Methemoglobinemia Detected in the Operating Room: A Case Report
We present a case and its management where congenital methemoglobinemia was detected in the operating room in a child scheduled for cardiac surgery. (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Computed Tomography Scan Evidence of Bronchospasm and Its Resolution During Computed Tomography Coronary Angiogram in a Child With Kawasaki Disease: A Case Report
Bronchospasm in children is common; however, due to its sudden nature, radiographic correlation is uncommon. We planned a computed tomography (CT) coronary angiogram for a 5-year-old child for evaluation of Kawasaki disease. The child started to desaturate during the CT scanning after intravenous contrast injection under conscious sedation. CT scan documented spasm of trachea and bronchi, as well as crowding of ribs and elevated diaphragm during the event. Repeat CT scan documented well-aerated lung fields. The development of acute bronchospasm under anesthesia results in definite changes in the CT scan of the thoracic cav...
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Distal Peripheral Nerve Stimulation Successfully Assesses Sciatic Nerve Integrity Following Parasacral Sciatic Motor Block: A Case Report
Following the placement of lumbar plexus and parasacral sciatic catheters for complex lower extremity surgery, a 19-kg child had dense sensory and motor blockades in the postanesthesia care unit. The surgical team felt obligated to exclude anatomically modifiable compression of the sciatic nerve and planned for surgical reexploration. Using an insulated short, beveled needle, direct electrical nerve stimulation distal to the parasacral sciatic block and proximal to the surgical site elicited tibial nerve motor function and confirmed nerve integrity. Peripheral nerve stimulation can be used to differentiate between the etio...
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Complete Endotracheal Tube Transection by Patient Bite: A Case Report and Algorithm for Fragment Identification and Extraction
We describe a case of a complete endotracheal tube (ETT) transection due to patient bite. The patient was intubated for postoperative pneumonia; during weaning of sedation, the patient was unable to tolerate pressure support ventilation (PSV) due to agitation. Adaptive support ventilation (ASV) improved patient comfort substantially. During a routine Spontaneous Breathing Trial (SBT) on PSV, the patient bit through the ETT, resulting in complete transection and an unsecured 20-cm airway fragment. Utilizing a multidisciplinary approach, we provided respiratory support and performed nasopharyngolaryngoscopy (NPL) to identify...
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
