Journal of clinical anesthesia
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Case Reports
Variable systolic pressure variation and dynamic hyperinflation due to an intrabronchial tumor.
Systolic pressure variation (SPV) is the cyclic change in systolic blood pressure secondary to positive-pressure ventilation. It is normally a good indicator of intravascular volume and often can be substituted for central venous pressure monitoring, but the reliability of SPV for this use depends on the multiple determinants of intrathoracic pressure remaining constant. ⋯ This situation, in turn, caused a marked increase in SPV but, more importantly, it increased variability of the SPV despite normal intravascular volume. We discuss the physiology of SPV and the implications of this case for the use of SPV as a monitor of intravascular volume.
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To determine the incidence and etiology of cardiopulmonary arrest during emergency intubation in the remote location by comparing two periods (1990-1995 vs. 1995-2002) at the same institution to assess whether immediate access to advanced airway devices and endotracheal tube-verifying devices altered the incidence of hypoxemia-driven cardiac arrest. ⋯ Cardiac arrest during emergency tracheal intubation outside the OR is relatively common compared with the OR environment. Airway-related complications played a prominent role, either singly or in combination with the patient's underlying physiological state. Immediate access to advanced airway devices and endotracheal tube-verifying devices appear to have a significant impact on the incidence of hypoxemia-driven cardiac arrest.
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Case Reports
Entrapment of pulmonary artery catheter in a suture at the inferior vena cava cannulation site.
Entrapment of a pulmonary artery catheter (Swan-Ganz catheter) in the heart, vena cava, or pulmonary artery is a very rare and serious complication that may lead to life-threatening complications such as cardiac rupture, pulmonary artery rupture, cardiac tamponade, among others, if not recognized and treated early. We report entrapment of a Swan-Ganz catheter in the purse-string suture at the inferior vena cava cannulation site for a patient undergoing aortic valve replacement. This situation required a repeat sternotomy to release the pulmonary artery catheter.