A&A practice
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There are various causes of dysfunction of the diaphragm. We present a case of diaphragm dysfunction caused by an excessive pneumoperitoneum in a 65-year-old woman. Her abdomen became distended during endoscopic investigation and circulatory failure occurred. ⋯ A diagnosis of dysfunction of the bilateral diaphragm was made by ultrasonography. Although nasal high-flow cannula therapy was required for several days, she was discharged from our hospital 2 weeks after surgery without any further complications. We should keep in mind that diaphragm dysfunction after excessive abdominal extension can be a cause of respiratory failure.
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During a cesarean hysterectomy for placenta percreta, transesophageal echocardiography was used to monitor volume status and guide resuscitation. After delivery of the neonate but before massive surgical hemorrhage, a thrombus appeared in the inferior vena cava. ⋯ An inferior vena cava filter was placed via an in situ internal jugular central venous cannula to prevent further embolic events. We believe transesophageal echocardiography is a useful monitor during surgery for placenta percreta.
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Case Reports
Novel Preoxygenation Technique to Deliver High-Flow Oxygen in a Patient With Facial Trauma: A Case Report.
This case demonstrates a novel preoxygenation technique in a patient with difficult access to the airway after a traumatic facial injury. To find a solution, a fusion of oxygenation equipment was trialed by altering and combining a tracheostomy mask and the tubing of an Optiflow circuit from which the nasal cannula component had been removed. ⋯ Effective preoxygenation was confirmed by arterial gas measurements. This study supports the use of this novel Optiflow-tracheostomy mask fusion device in appropriately selected cases.
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Surgery requires many electrically driven devices. Three events occurred recently in an operating room (OR) suite circa the 1980s wherein circuit breakers tripped due to overloaded circuits. This led to us to (1) increase OR electric capacity; (2) record each instrument's power requirements, map their OR location, and determine when during surgery they were used; (3) provide users with instruction and diagrams into which outlet to plug each instrument. When introducing surgeries requiring devices, especially with high electrical power (current or amperage) demands, or renovating older or planning new ORs, it is important to provide ORs with sufficient electric current, circuits, and outlets.
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We report the case of a 60-year-old man who underwent open radical prostatectomy for prostate adenocarcinoma. He had no known cardiac disease or symptoms other than controlled hypertension and remote history of cocaine use. ⋯ Subsequent cardiac workup showed no abnormalities. We believe the cause of arrest was sugammadex, considering the time of administration, the absence of cardiac disease, and stable operative course.