A&A practice
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We report a series of 20 neonates and infants (18 born preterm) who underwent laparoscopic inguinal hernia repair with caudal anesthesia, oxygen via nasal cannula, and intravenous anesthesia. Surgery was successful in all cases without airway instrumentation or intraoperative complications. Sedation was provided with dexmedetomidine, propofol, and remifentanil. ⋯ Laparoscopy allowed unplanned bilateral repair in 2 cases. Caudal with intravenous anesthesia without airway instrumentation is a viable technique for laparoscopic inguinal hernia repair. Avoiding general endotracheal anesthesia may reduce perioperative complications and influence postoperative disposition.
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In January 2020, a global pandemic was declared by the World Health Organization authorities for coronavirus disease 2019 (COVID-19). Since then, we have looked for ways to avoid transmission with mitigation measures and social distancing. ⋯ Many innovations have been proposed to assist providers including barriers to use during airway management. We present adaptations to previously described intubation or "aerosol" boxes.
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Renal colic is a common cause of pain; however, there have been few reports of treating this pain with regional anesthesia. We report on a 49-year-old man presenting with severe left flank pain resulting from a 4-mm stone in the left ureter. ⋯ The pain resolved over the following 30 minutes, and the patient was discharged home. No further pain was experienced before and while subsequently passing the stone.
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We report for the first time therapy-resistant hypernatremia (plasma sodium concentration ≥150 mmol per liter) developing in 6 of 12 critically ill coronavirus disease 2019 (COVID-19) patients age 57-84 years requiring mechanical ventilation. There was no correlation between plasma sodium concentrations and sodium input. ⋯ These findings are consistent with abnormally increased renal sodium reabsorption, possibly caused by increased angiotensin II activity secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced downregulation of angiotensin-converting enzyme 2 (ACE2) receptors. As hypernatremia was associated with increased length of intensive care unit stay, special attention should be paid to the electrolyte status of COVID-19 patients.
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We report a case of massive engorgement of an asymptomatic tongue hemangioma with the use of a supraglottic airway device (SGA) during general anesthesia for transurethral resection of a tumor on the lateral wall of the urinary bladder. This was probably a result of obstruction of the venous drainage of the hemangioma due to the pressure exerted by the inflated cuff of the SGA. The SGA was removed and the trachea was intubated and the engorgement resolved completely in a few hours.