A&A practice
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Acute lower extremity ischemia from septic emboli is a surgical emergency. Timely diagnosis and management are critical to improve patient outcome. However, traditional diagnostic modalities such as intraoperative angiogram are time-consuming, require special equipment and personnel, and introduce contrast exposure for critically ill patients. ⋯ We present a case where femoral occlusive septic emboli were identified by point-of-care ultrasound after mitral valve replacement. This facilitated early surgical embolectomy and limb salvage. We suggest that perioperative point-of-care ultrasonography should be used as a first-line screening test in patients with acute lower extremity ischemia.
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Anterior laryngeal web is a rare anomaly which is usually asymptomatic in infancy. This translates into a high incidence of unanticipated difficult intubation in these patients with consequent airway morbidity in the form of tracheostomy. ⋯ After multiple failed intubation attempts with direct laryngoscopy, use of CMAC video laryngoscope improved the glottic view, enabled us to diagnose the presence of a thick anterior laryngeal web and intubate the child. We have also highlighted a pivotal history which may improve its preoperative detection.
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Dorsal root ganglion (DRG) stimulation has recently emerged as a treatment for persistent neuropathic pain, but the permanent implantation of stimulator leads and the pulse generator can be difficult and is sometimes associated with complications. We used a single-incision approach to tunnel and implant the leads and pulse generator for DRG stimulation treatment in a patient suffering from intractable foot pain. At long-term follow-up, the patient experienced a decrease in pain intensity and improvement in function, without any complications. A single-incision implantation technique for DRG stimulator implantation may simplify implantation and decrease the risk of complications.
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Case Reports
Laryngeal Mask Airway Embedded With Pharyngeal Suction Catheters for Rhinoplasty: A Case Report.
A flexible laryngeal mask airway device (LMAD) embedded with 2 pharyngeal suction catheters was used for a young female patient who underwent a revision rhinoplasty, septoplasty, and chin implant. The modified LMAD was constructed by attaching 2 suction catheters onto the back of the mask; it functioned well without signs of malfunction or complications, with a total of 71 mL of blood evacuated from the pharyngeal area during the five and a half hour surgery. The patient emerged from anesthesia without coughing or straining, and reported no sore throat or nausea/vomiting in the recovery room.