Journal of clinical anesthesia
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A 75-year-old female presented for left total hip reimplantation and suffered pulseless electrical activity arrest upon lateral positioning and administering vancomycin. Resuscitation was achieved according to Advanced Cardiac Life Support protocol. Post-event echocardiography showed hypertrophic cardiomyopathy with asymmetrical septal thickening, an under-filled left ventricle, dynamic left ventricular outflow obstruction, and severe mitral regurgitation related to systolic anterior motion of the mitral valve. ⋯ After medical optimization of the patient's cardiomyopathy and an evaluation of potential intraoperative allergic triggers, the patient underwent a successful hip reimplantation without incident. This case presents a novel combination of events leading to intraoperative cardiac arrest. Rapid identification and an understanding of the cause(s) of cardiac arrest in this setting are critical for effective perioperative care.
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Comparative Study Observational Study
A comparison of the I-Gel supraglottic device with endotracheal intubation for bronchoscopic lung volume reduction coil treatment.
To compare the use of the I-gel airway with orotracheal intubation (OTI) for bronchoscopic lung volume reduction (BLVR) coil treatment in patients with severe chronic obstructive pulmonary disease (COPD) with heterogeneous emphysema, since it has been proved that supraglottic airways have lower incidence of postoperative respiratory complaints compared to OTI. ⋯ The I-gel airway ensures appropriate ventilation and makes the use of the flexible fiberoptic bronchoscope quite easy. Therefore, we consider that the I-gel device is an effective and safe alternative to classical OTI for airway management in COPD patients with severe heterogeneous emphysema undergoing BLVR coil treatment.
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Inclusion body myositis is a painless inflammatory myopathy affecting older adults. It manifests as progressive muscle atrophy and weakness, typically affecting proximal lower extremity muscles initially but insidiously progressing to affect other muscles, including bulbar (oropharyngeal) muscles and the diaphragm, and leading to dysphagia and respiratory insufficiency. This study reviews the perioperative outcomes of patients with inclusion body myositis who received general anesthesia. ⋯ Our patients with inclusion body myositis had uneventful perioperative outcomes following general anesthesia with depolarizing and nondepolarizing muscle relaxants. The small patient cohort in our series precludes a definitive conclusion regarding the safety of anesthetic agents in this patient population.
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To determine the number of difficult airway (DA) carts required based on the number of anesthetising locations and patients risk of DA. ⋯ With continuing resource constraints, proper planning of human and capital resources for DAs needs to be addressed without compromising patient safety. It is recommended that every block of 15-20 sites be equipped with a DA cart, that anaesthesia groups develop and rehearse DA algorithms with available equipment, and that preoperative anaesthesia clinics be used to identify DA therefore providing logistical leverage.
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Hemodynamic derangements have been reported after surgery involving upper cervical spine. Similar observations, however, are rare during a lumbar spine surgery. We share our experience in a patient who had 2 episodes of bradycardia leading to transient asystole while undergoing lumbar discectomy for prolapsed intervertebral disc. The risk of life-threatening hemodynamic disturbances during seemingly uncomplicated surgery in prone position has been emphasized.