Journal of clinical anesthesia
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We report a case of tracheal and endotracheal tube cuff perforation that occurred intraoperatively during a ventriculoatrial shunting procedure for a patient with normal pressure hydrocephalus. Unusual tracheal anatomy and technique were contributory factors. Use of noninvasive imaging devices to guide the intraoperative placement of catheters may avoid many of the complications related to anatomy, skill, and technique. The method of diagnosis, prevention, and management is discussed.
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Patients with diabetes and insulin pumps may need their insulin therapy modified during surgery. Often, this is done with blood glucose as the end point. ⋯ This case demonstrates that changes in insulin therapy warrant not only close monitoring of blood glucose, but also of serum potassium. This patient's comorbidities and treatments that could alter potassium homeostasis are also reviewed.
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This case report illustrates that median, radial, and ulnar nerve blocks at the elbow provides anesthesia for ambulatory carpal tunnel release surgery. This report discusses 3 patients with medical conditions, including vascular access problems and morbid obesity, which made nerve blocks at the elbow advantageous compared with other anesthetic techniques. ⋯ The blocks are easy to perform and set up quickly, and using long-acting local anesthetics, elbow blocks provide postoperative pain control for approximately 10 hours. The nerve blocks at the elbow facilitate the perioperative process by being done out of the operating room and providing prolonged pain control without the need for opioids, so nausea may be avoided.