A&A practice
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A patient with ankylosing spondylitis in a "can't intubate, can't oxygenate" situation was rescued with cannula cricothyrotomy and transtracheal jet oxygenation. The case revealed clinical and systematic weaknesses, leading to standardization and reorganization of our equipment. ⋯ Cognitive aids specific to emergency front-of-neck access (eFONA) were created and placed strategically with the eFONA equipment to prompt and guide operators during airway emergencies. The aids have also been incorporated into our training curriculum to encourage their use.
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Case Reports
Use of Continuous Glucose Monitoring to Facilitate Perioperative Glycemic Management: A Case Report.
Perioperative glycemic management remains an important variable in a host of postoperative outcomes, including wound infection, reoperation, and death. Patients with diabetes mellitus are increasingly utilizing continuous glucose monitors to assist with glycemic management; the ability to harness the intensive monitoring capabilities of continuous glucose monitoring (CGM) technology perioperatively presents a promising opportunity to improve patient outcomes. Here, we assessed the accuracy of CGM compared to capillary point-of-care and arterial blood analysis in 2 cases where CGM was utilized as an adjunct method of perioperative glucose monitoring.
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Following the placement of lumbar plexus and parasacral sciatic catheters for complex lower extremity surgery, a 19-kg child had dense sensory and motor blockades in the postanesthesia care unit. The surgical team felt obligated to exclude anatomically modifiable compression of the sciatic nerve and planned for surgical reexploration. Using an insulated short, beveled needle, direct electrical nerve stimulation distal to the parasacral sciatic block and proximal to the surgical site elicited tibial nerve motor function and confirmed nerve integrity. Peripheral nerve stimulation can be used to differentiate between the etiologies of motor blockade in time-critical situations.
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Review Case Reports
A Case Report of the Anesthetic Management of a Parturient With Congenital Hypofibrinogenemia and Complete Placenta Previa.
A multidisciplinary approach among the obstetric, hematological, pharmaceutical, nursing, and anesthetic team proved essential for the successful peripartum management of a gravida 3, para 2 female with a new diagnosis of congenital hypofibrinogenemia complicated by a complete placenta previa. The patient presented to labor and delivery triage with vaginal bleeding. This case report describes the management of this parturient and presents a review of the literature available for the anesthetic management of parturients with congenital hypofibrinogenemia.