A&A practice
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Case Reports
Airway Management of Near-Complete Tracheal Transection by Through-the-Wound Intubation: A Case Report.
We present an approach to airway management in a patient with machete injuries culminating in near-complete cricotracheal transection, in addition to a gunshot wound to the neck. Initial airway was established by direct intubation through the cricotracheal wound. ⋯ This case offers insight into a rarely performed approach to airway management. Furthermore, our case report demonstrates that, in select airway injuries, performing through-the-wound intubation engenders a multitude of benefits.
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Although the primary goal of operating room (OR) management is to minimize inefficiencies, it may be difficult for OR managers to track metrics when one extrapolates possible scenarios across every OR on a daily basis. With the ability to visualize the statistical relationships to help simplify the analysis of large datasets, a more elaborate efficiency framework can be established using Pareto optimality (or performance frontiers), a multicriteria framework that includes variables that serve as proxies for a variety of outcomes. Applied to OR management, performance frontiers allow for the evaluation of common and well-understood issues of under- and over-utilized time.
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Hereditary spastic paraplegia (HSP), also known as familial spastic paraparesis or Strümpell-Lorrain disease, is a rare group of inherited disorders characterized by progressive spastic weakness in the lower limbs due to axonal degeneration of the corticospinal tracts. We describe the anesthetic management of a 52-year-old man with HSP who underwent an Ivor-Lewis esophagectomy for esophageal adenocarcinoma. This is the first report in the literature describing the anesthetic management of a patient with HSP successfully undergoing complex thoracoabdominal surgery. Key to the provision of postoperative analgesia was the intraoperative placement of catheters in the right thoracic paravertebral space and retro-rectus plane for continuous infusion of ropivacaine 0.2% for 3 days, as well as a fentanyl patient-controlled analgesia for 7 days.