A&A practice
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Ambiguity in defining difficult intubation involving video laryngoscopy (VL) may pose potential risks to patients. To improve airway documentation practices, we surveyed anesthesia providers on their difficult intubation interpretations and VL use. ⋯ These results suggest that clinicians inconsistently interpret difficult intubations, especially in cases involving VL. There is a need for provider education and standardization of airway documentation, inclusive of VL.
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We report a case of Xp21 deletion syndrome, a contiguous gene syndrome associating glycerol kinase deficiency, Duchenne muscular dystrophy, and congenital adrenal hypoplasia. This results in a contraindication to the use of all halogenated agents and of propofol. ⋯ We were unfortunately unable to document the metabolic consequences of this glycerol load. We suggest that if propofol is deemed necessary in such cases, it should only be used as a bolus dose of a 2% solution.
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Case Reports
Perioperative Echocardiography to Confirm Correct Central Venous Catheter Placement: A Case Report.
Central venous catheterization is widely regarded as a safe procedure by anesthesiologists and intensivists, but insertion complications and catheter malposition remain challenges for the clinicians performing central venous catheter (CVC) insertion. We report a case in which a right internal jugular CVC was inserted under ultrasound guidance and was found to be malpositioned after sternotomy into an anomalous posterior thymic vein. Therefore, we recommend confirming the correct position of CVC with transesophageal echocardiography if such is indicated for the perioperative period and emphasize the importance of a correct J-tip of the guidewire when placing a CVC.
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Case Reports
A Tale of 2 Tubes for Emergency Management of Airway Obstruction From an Anterior Mediastinal Mass: A Case Report.
Anterior mediastinal masses are challenging. As induction of general anesthesia may result in complete airway obstruction or hemodynamic collapse, maintaining spontaneous ventilation and advancing the endotracheal tube (ETT) distal to the mass are recommended. ⋯ Despite maintaining spontaneous ventilation, airway obstruction persisted following placement of the ETT proximal to the obstruction. After advancing the ETT into the right mainstem bronchus distal to the mass, hypoxemia persisted, prompting placement of a second ETT into the left mainstem bronchus to overcome the obstruction and provide adequate oxygenation.