A&A practice
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We report a novel technique for the management of subglottic stenosis in a neonate. The initial endotracheal intubation did not provide adequate mechanical ventilation due to a significant air leak. ⋯ We successfully inserted an endotracheal tube deep enough to maintain adequate mechanical ventilation. This technique is a viable rescue strategy in this clinical scenario.
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Case Reports
Navigating Goals of Care While Confronting an Urgent, Difficult Intubation: A Case Report.
Urgent airway management is challenging because time constraints limit thorough evaluation and planning before endotracheal intubation. In this report, we describe a case in which an airway history review revealed extraordinarily complex airway anatomy that led to a decision not to attempt intubation in a man with end-stage chronic obstructive pulmonary disease. ⋯ We discuss the importance of a multidisciplinary approach that includes the patient, their family, and consultants when high-risk intubation is contemplated. The ethical role of the anesthesiologist is also discussed.
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Case Reports
Early Massive Pulmonary Embolism After Total Hip Arthroplasty in a Patient With Behcet Disease: A Case Report.
Venous complications in Behcet disease (BD) affect nearly 40% of patients. We describe a woman with BD who presented with a massive bilateral pulmonary embolism 30 hours after total hip arthroplasty. The patient underwent surgical thrombectomy and venoarterial extracorporeal membrane oxygenation. ⋯ Therefore, continuation of methotrexate perioperatively should be considered in patients with BD. Systematically performing preoperative deep vein thrombosis screening should be also considered. The patient also had diabetes mellitus treated with metformin and sitagliptin preoperatively.
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Regional anesthetic blocks, especially in-dwelling catheters, are infrequently used in neonates and infants. The following report describes a neonate with a gangrenous right upper extremity requiring multiple painful debridements over several weeks. ⋯ After the initial procedures, bolus doses of a local anesthetic agent provided surgical anesthesia for dressing changes, thus obviating the need for multiple general anesthetics. This case demonstrates the potential efficacy of regional techniques to both treat pain and limit anesthetic exposures in neonates.