Journal of clinical anesthesia
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We present the case of a patient who first presented with unexpected difficult laryngoscopy and intubation after induction of general anesthesia. After multiple failed attempts using direct laryngoscopy, tracheal intubation was successfully performed with the Intubating Laryngeal Mask Airway. He returned to the operating room 5 days later for another surgical procedure, and intubation was performed with the Direct Coupler Interface Video Laryngoscope on the first attempt by the same anesthesiologist.
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Case Reports
Soft palate perforation during orotracheal intubation facilitated by the GlideScope videolaryngoscope.
We report a case in which a videolaryngoscope was used to facilitate endotracheal intubation in a patient with a large exophytic mass involving the right supraglottis. After intubation, it was noted that the soft palate had been perforated by the styletted endotracheal tube. The defect closed spontaneously postoperatively within 9 days.
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A 61-year-old patient with severe stump pain required hospitalization and intravenous opioids for pain control. After evaluation by our anesthesia pain management service, we concluded that the patient had a neuroma at the site of sciatic nerve transection and that injection of a mixture of local anesthetic and corticosteroid at the site of the neuroma was the most appropriate management. Because the alternative methods of nerve localization (eg, motor stimulation, paresthesia) were unlikely to be successful, we felt that the most reliable way to accomplish this task was to use live ultrasound guidance. After a series of 4 ultrasound-guided blocks with bupivacaine and methylprednisolone acetate, the patient's pain was alleviated to the point at which it was managed with occasional doses of oral opioids.
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Case Reports
Occurrence of pneumothorax during noninvasive positive pressure ventilation through a helmet.
A 79-year-old woman presented with hypoxemic acute respiratory failure secondary to pneumonia and was started on continuous noninvasive positive pressure ventilation (NPPV) by helmet. Patient improved over first two days of NPPV, but worsened suddenly on the third day because of development of a pneumothorax. Pneumothorax may have been caused by barotrauma from desynchronization between patient and ventilator.
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A patient who sustained a posterior shoulder subluxation injury after being positioned in the lateral decubitus head-down position during emergence from general anesthesia is presented. It is postulated that the injury occurred as a result of violent retching while in the lateral position.