A&A practice
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Factor X (FX) deficiency is a rare coagulopathy that may cause bleeding complications in parturients. The literature on rotational thromboelastometry (ROTEM; Instrumentation Laboratory, Bedford, MA) to guide factor repletion and neuraxial placement during partuition is limited. ⋯ Thromboelastometry may be a valuable adjunct to conventional monitoring in patient management. A limitation of this report is that coagulation tests and thromboelastometry were not assessed at identical timepoints.
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Case Reports
Use of a Rigid Bronchoscope as the Sole Prebypass Airway During Pediatric Tracheal Tumor Resection: A Case Report.
We describe the anesthetic and operative techniques utilized for a tracheal tumor resection in a pediatric patient with 95% tracheal occlusion. In prior tracheal tumor cases that dictated complete resection, our team had been able to comfortably bypass a tumor with an endotracheal tube. In this case, we could not intubate past the tumor. A rigid bronchoscope was able to be placed past the tumor, so we continued with sternotomy and dissection before cardiopulmonary bypass while ventilating through that bronchoscope as our definitive airway.
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Case Reports
Water Accumulation in Amsorb Canister May Cause Inspiratory Flow Obstruction: A Case Report.
A patient received closed-circuit anesthesia from a General Electric Avance S/5 (GE Healthcare, Madison, WI) anesthesia machine during a robotic abdominal procedure. With return of spontaneous ventilation at the end of the procedure, the negative airway pressure alarm began to sound, and a negative airway pressure of 10-15 cm H2O was observed with each breath. ⋯ There was considerable condensation on the walls of the Amsorb canister, and on disassembly, the sponge at the bottom was wet. Experimentation with an empty canister revealed that as little as 30 mL of water in the sponge can reproduce our observations.
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Endobronchial blockers are frequently used for lung isolation in children <8 years of age. The aim of our report is to highlight the problem that we have encountered with the wire-guided endobronchial blocker (WEB), where the wire loop used to couple the blocker and the fiberoptic scope (FOS) may straddle the carina. We describe the "uncoupled head turn technique" that we have adopted to avoid this problem. If the coupled technique is deemed necessary, a method to keep the wire loop snug around the FOS is described to avoid the straddling problem.