A&A practice
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Case Reports
Airway Management Through a Facial Defect Resulting From Noma (Orofacial Gangrene): A Case Report.
At a rural district hospital in Burundi, a 3-year-old severely malnourished girl with Noma presented to the operating room for placement of a gastrostomy tube. The child had a large left-sided facial defect as well as trismus. ⋯ Given that the hospital has no fiberoptic bronchoscope, direct laryngoscopy and intubation were performed directly through her facial defect. After securing the airway, the surgery proceeded without difficulty.
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Case Reports
Neuroleptic Malignant Syndrome Secondary to Quetiapine in Critical Care: A Case Report.
Quetiapine, an atypical antipsychotic, is widely used to treat delirium in intensive care units (ICUs). Studies demonstrate its efficacy and favorable safety profile. We report a case of an elderly patient who developed clinical and biochemical evidence of neuroleptic malignant syndrome (NMS) 5 days after quetiapine was commenced. ⋯ Quetiapine-induced NMS has occurred with long-term use in the elderly in the outpatient setting. However, NMS has not previously been reported after treatment of ICU delirium. NMS is an important complication to consider before prescribing quetiapine in the ICU.
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Case Reports
Continuous Intravenous Lidocaine Provides Effective Pain Control in a Palliative Child: A Case Report.
Lidocaine infusion is often used as part of a perioperative, multimodal pain management plan. We present its use to treat an 8-year-old child with devastating headaches. His symptoms stemmed from an inoperable supratentorial ependymoma that was causing thalamic bleeding and increased intracranial pressure. ⋯ These effects prevent lucidity for interactions, confound neurologic examination. A lidocaine infusion resulted in significant pain relief without these negative side effects. We discuss lidocaine infusion use and considerations for children suffering from intractable headaches.
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Patients with Pierre Robin sequence present with numerous anatomical abnormalities that make mask ventilation and tracheal intubation challenging. In this case series, we describe a unique way to overcome upper airway obstruction with the placement of a supraglottic airway in 4 children with Pierre Robin sequence followed by flexible bronchoscopic nasotracheal intubation. This new approach is proven to be a successful method to overcome severe upper airway obstruction, provide continuous oxygenation, and allows nasotracheal intubation for intraoral procedures.
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In performing pulmonary endarterectomy (PEA) for a patient with chronic thromboembolic pulmonary hypertension (CTEPH), we encountered methemoglobinemia that was unmasked by hypothermia while on cardiopulmonary bypass (CPB). The patient on dapsone therapy for antiphospholipid antibody syndrome had developed acquired methemoglobinemia that went undiagnosed because her cyanosis was believed to be due to CTEPH and the resulting ventilation-perfusion (V/Q) mismatch. Although pharmacological triggers for methemoglobin are well known, causation by hypothermia is not described. Monitoring saturation while on CPB was challenging because of nonpulsatile blood flow but was overcome using cerebral oximetry.