Canadian journal of anaesthesia = Journal canadien d'anesthésie
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Whenever possible, neuraxial anesthesia is the preferred technique for Cesarean delivery; however, under certain circumstances, general anesthesia remains the most appropriate choice. The purpose of this Continuing Professional Development module is to review the key issues regarding general anesthesia for Cesarean delivery. ⋯ A general anesthetic for Cesarean delivery should be based on the following principles: preventing aspiration, anticipating a difficult intubation, maintaining oxygenation, insuring materno-feto-placental perfusion and maintaining a deep level of anesthesia to avoid intraoperative awareness while minimizing neonatal effects.
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Observational Study
Angular change in the line of vision to the larynx: implications for determining the laryngoscopic view.
We measured the angular change from the line of vision to the larynx around the upper incisors under defined laryngoscopic forces and investigated its association with the laryngoscopic view. ⋯ Compared with ELG, DLG is associated with a larger angle difference, i.e., a larger gap between the underside of the blade and the thyroid notch at all laryngoscopic forces (10-50 N). The concept of angle difference, based on the angular change in the line of vision around the upper incisors, may provide a new approach to understanding DLG. This study was registered with the Clinical Research Information Service, registration number KCT0000433.
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When exposed in the perioperative period to blood components containing immunoglobulin (Ig)A IgA-sensitized IgA-deficient patients are at an increased risk of transfusion-associated anaphylaxis. We present the case of an IgA-deficient patient whose candidacy for double-lung transplantation was under review in the preoperative period. ⋯ Through a multidisciplinary approach [corrected], a successful transplantation outcome was achieved in an IgA-deficient patient undergoing major surgery. Strategies to mitigate risk include the procurement and transfusion of IgA-deficient components, which may be challenging or untenable in emergent perioperative settings.