A&A practice
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The relatively high cost of sugammadex compared to neostigmine limits its widespread use to reverse neuromuscular blockade, despite its faster onset and more complete clinical effect. While ensuring timely access to sugammadex is important in improving perioperative safety, it is also vital to control unnecessary spending. ⋯ Monthly spending on sugammadex decreased by 52% ($70,777 vs $33,821), while medication access increased via automated medication dispensers in each operating room. Clinical usage decreased by one-third, with presumed increased adherence to dosing guidelines.
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Kleefstra syndrome (KS) is an autosomal dominant disorder caused by a chromosomal deletion at 9q34.3 resulting in pathogenic variants of the gene that codes for the enzyme, euchromatin histone methyltransferase 1 (EHMT1). KS is a rare, yet clinically relevant congenital disorder for anesthesiologists because of its potential for cardiac and craniofacial involvement. We present a 3-month-old patient with KS who required anesthetic care for diagnostic laryngoscopy and rigid bronchoscopy. The end-organ effects of KS are reviewed and our anesthetic care presented.
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We present the case of a 25-year-old man with a significant neck mass and describe the technique used for managing his airway given limited equipment in an austere environment. Physical examination and imaging revealed significant proximal airway involvement. Without access to a fiberoptic bronchoscope, we sought a technique that might avoid contact with the mass from both the laryngoscope and endotracheal tube. In this case report, we describe our approach to left paraglossal laryngoscopy and intubation under general anesthesia-a method not well described in the literature and proved to be imperative for our airway management.
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Case Reports
Intraoperative Diagnosis of Coronavirus Disease 2019 in an Asymptomatic Patient: A Case Report.
Patients with coronavirus disease 2019 (COVID-19) with variable clinical presentations are encountered in the perioperative setting. While some have already been diagnosed and are symptomatic, others have undiagnosed, asymptomatic COVID-19. ⋯ We report an intraoperative diagnosis of COVID-19 in an asymptomatic patient, prompted by clinical signs. To control a pandemic such as COVID-19, a high index of suspicion is pivotal when caring for asymptomatic patients in the perioperative setting.