A&A practice
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Case Reports
Anesthetic Considerations for an Adult With Bannayan-Riley-Ruvalcaba Syndrome: A Case Report.
Anesthetic considerations for adults with Bannayan-Riley-Ruvalcaba syndrome, part of the PTEN (phosphatase and tensin homolog) hamartoma tumor syndrome, are not well described. As patients may require surgical intervention for associated musculoskeletal, intestinal, oncologic, or soft tissue masses, knowledge of implications of anesthesia is necessary. ⋯ This report describes a patient with typical features, nonreassuring external airway anatomy, and developmental delay, which precluded an awake airway management technique. The airway was secured with the use of high-flow nasal oxygen and videolaryngoscopy.
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Traditional intravenous anesthetics and opioid analgesics are susceptible to inducing hemodynamic instability. Herein, we describe a case of open reduction and internal fixation of a femoral neck fracture in a patient with severe aortic stenosis. ⋯ During the surgical procedure, the need for circulatory agonist was reduced to a single dose, and satisfactory pain management was achieved. This approach represents an alternative method for patients with circulatory risk undergoing femoral surgery.
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Prolonged intubation is a common cause of injury to the posterior larynx often resulting in cricoarytenoid joint (CAJ) fixation and posterior glottic stenosis (PGS). We present a case of respiratory failure due to acute bilateral CAJ fixation and PGS following only 2 days of intubation for routine cardiac surgery. ⋯ Clinicians should remain vigilant for laryngeal injury presenting as CAJ fixation and PGS. Prompt surgical consultation is advised as early intervention is associated with reduced morbidity.
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Nasotracheal intubation is an essential component of anesthetic management for intraoral and mandibular surgeries. Direct nasotracheal intubation can occasionally be difficult and require an initial oral endotracheal tube (ETT) placement with subsequent conversion to a nasal ETT. ⋯ However, execution can be challenging and limited by available resources. This report re-examines conventional oral to nasal ETT conversion techniques and describes another innovative approach utilizing equipment more readily available in the operating room or as an option when difficulty is encountered with conventional conversion techniques.
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Anesthetic induction in children can have significant psychological and behavioral impacts. Strategies like premedication or parental presence for induction may reduce distress. ⋯ The use of parental presence by video may aid in this transition. It might also be a reasonable approach for those children who have adverse reactions to medications commonly used for anxiolysis before procedures.