Journal of clinical anesthesia
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Minor complications of inadvertent dural puncture during attempted epidural anesthesia are common, related to the size of the needle and the incidence of postdural puncture headache. Serious complications are much less common. We report a case where inadvertent dural puncture with an 18-gauge epidural needle was associated with the creation of intracranial and spinal subdural hematoma.
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Randomized Controlled Trial
Use of the Rapiscope vs chest auscultation for detection of accidental bronchial intubation in non-obese patients undergoing laparoscopic cholecystectomy.
Main stem bronchial intubation is not always detected by routine means and may occur more frequently during laparoscopic procedures. Tracheal tube positional changes in non-obese patients undergoing laparoscopic cholecystectomy were detected by either the Rapiscope (Cook Critical Care, Bloomington, Ind) or chest auscultation. ⋯ The Rapiscope detected significantly more events of endobronchial intubation as compared with chest auscultation; it could be considered useful during procedures where tracheal tube movements are potential.
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The Accreditation Council for Graduate Medical Education Outcome Project requires teaching and evaluation of 6 core competencies, one of which is professionalism. Because of this initiative, anesthesiology residency programs are obliged to teach and evaluate professionalism for anesthesiology residents. We decided to create a system that would allow the teaching and evaluation of professionalism in the specific context of anesthesiology.
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Radial artery cannulation may be unsuccessful in the most experienced of hands using the conventional palpation method. Repeated attempts may render the standard wrist site difficult to cannulate due to vasospasm, hematoma formation, or intimal dissection. Cannulation of other arterial sites may be difficult due to inaccessibility or more prone to adverse outcomes. ⋯ As the trajectory is in full view of the ultrasound probe, the technique has a very high success rate. We have used ultrasonography in over 30 cases as a rescue technique after unsuccessful attempts at radial artery cannulation. The technique is described here illustrated with 3 typical cases.
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We describe two cases of flash fires in the oropharynx, secondary to electrocautery during adenotonsillectomies. We believe that in both cases, the leak around the uncuffed endotracheal tubes raised the oxygen concentration in the oropharynx. Cuffed endotracheal tubes provide many advantages, and their use should strongly be considered during adenotonsillectomy in children when electrocautery is to be used.