A&A practice
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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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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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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.
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The Tritube is a narrow-bore cuffed tracheal tube (outer diameter 4.4 mm and inner diameter ~2.4 mm) that permits effective alveolar gas exchange using flow-controlled ventilation. Constant gas flow delivers physiological minute volumes, within preset pressure limits, and applies suction to the airway during expiration. ⋯ Cuff inflation protects the lower airway and produces a motionless operating field. We describe the structure of the device, discuss its benefits, and suggest how it should be used clinically.
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The delivery of drugs from the manufacturer to the hospital is a complex process. Despite numerous safeguards, lapses may occur, creating the potential for patient harm. ⋯ No patients received the anesthetic. This report describes how such an error occurred, explains the differences between veterinary and human medications, and emphasizes the importance of vigilance in the drug supply chain to prevent patient harm.