A&A practice
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Case Reports
Hypoxemic Cardiac Arrest from Aspiration of a Cracker in the Postanesthesia Care Unit: A Case Report.
A 71-year-old woman with coronary artery disease presented for carotid artery revascularization. After general anesthesia, the patient arrived in stable condition to the postanesthesia care unit. While awaiting transfer to her inpatient room, telemetry alarms alerted her nurse, who found the patient unresponsive, cyanotic, and pulseless. ⋯ On oropharyngeal examination, food particles were observed and suctioned. The patient then coughed up additional cracker pieces. This case highlights the risk of aspiration from dry, solid foods in the elderly during the postanesthesia recovery period.
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Referred chronic shoulder pain may arise from diaphragmatic irritation. It can potentially be alleviated by blockade of the phrenic nerve. ⋯ Patients experienced significant pain relief and a reduction in opioid consumption after receiving an ultrasound-guided phrenic nerve block. While the phrenic nerve block shows promise for pain relief, carefully evaluating its benefits and risks is recommended before considering its application in selected cases.
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Case Reports
Opioid-Obviating Analgesia for Adolescent Multilevel Spinal Fusion Surgery: A Problem-Based Learning Discussion.
A female teenager with a history of polysubstance use, including a recent overdose, is scheduled for multilevel posterior spinal fusion surgery due to idiopathic scoliosis and has asked to avoid the use of opioids in the context of her upcoming surgery. This problem-based learning discussion (PBLD) focuses on the examination of the care of a spinal fusion patient that allowed for the successful provision of opioid-obviating care.
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Primary encephaloceles are congenital mesodermal defects that result in brain tissue protruding through the skull. These defects most commonly occur occipitally but can be present anywhere in the calvarium. ⋯ Basal meningoencephaloceles with cleft palate defects are the rarest form, with very few reports discussing anesthetic implications. We report a case of a giant basal meningoencephalocele that involves the nasal and oral cavities with a risk of thecal sac rupture.
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The anesthesia gas scavenging system (AGSS) removes waste gases from the anesthesia machine. Within the AGSS, safety features prevent excessive pressures from affecting ventilation. ⋯ Both cases suffered delayed identification intraoperatively but patients did not experience postoperative complications. These cases highlight the importance of daily scavenger system prechecks, the potential physiologic implications of AGSS malfunctions, and the importance of preplanned contingencies for machine failure.