A&A practice
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Respiratory failure in coronavirus disease 2019 (COVID-19) patients with prolonged endotracheal intubation may require a tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube placement to facilitate recovery. Both techniques are considered high-risk aerosol-generating procedures and present a heightened risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for operating room personnel. We designed, simulated, and implemented a portable, continuous negative pressure, operative field barrier system using standard equipment available in hospitals to enhance health care provider safety during high-risk aerosol-generating procedures.
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Case Reports
Two-Stage Fiberoptic Intubation in an Infant With a Rare Congenital Laryngopharyngo-Cutaneous Fistula: A Case Report.
Branchial arches represent embryological precursors of the face, neck, and pharynx, and developmental abnormalities of these branchial arch derivatives can lead to airway anomalies. We report definitive repair of the fistula in an infant with a rare congenital laryngopharyngo-cutaneous fistula. This is the first report that describes a 2-stage fiberoptic intubation, a challenging technique performed for airway management of the aforementioned fistula in a patient with a difficult airway.
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We describe 2 cases in which failure to properly interpret paced heart rhythms in patients with cardiac implantable electronic devices (CIEDs) undergoing surgery resulted in adverse consequences including unnecessary invasive procedures, surgical delays, and patient dissatisfaction. Both cases occurred even though experienced clinicians were involved, and all perioperative recommendations were followed. Although it is sometimes argued that anesthesiologists are not directly responsible for CIED management, they are often held accountable when problems arise. These cases reinforce the need for anesthesiologists to not only adhere to all key practice recommendations but to also understand CIED functions and common pitfalls.
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This single-center retrospective study evaluated a protocol for the intubation of patients with confirmed or suspected coronavirus disease 2019 (COVID-19). Twenty-one patients were intubated, 9 of whom were found to have COVID-19. ⋯ COVID-19 patients had lower peripheral capillary oxygen saturation by pulse oximetry (Spo2) nadirs during intubation (Spo2, 73% [72%-77%] vs 89% [86%-94%], P = .024), and a greater percentage experienced severe hypoxemia defined as Spo2 ≤80% (89% vs 25%, P = .008). The incidence of severe hypoxemia in COVID-19 patients should be considered in the development of guidelines that incorporate high-flow nasal cannula and noninvasive positive pressure ventilation.