Journal of clinical anesthesia
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Although the use of a gum-elastic bougie to secure an airway is well described, its use during extubation is not well documented. A bougie was passed through the endotracheal tube (ETT) prior to extubation in anticipation of possible reintubation of a patient with a difficult airway. Once the bougie was in place, the ETT was removed over it. Later, when the patient's airway did become compromised, the trachea was rapidly reintubated using the bougie, without the need for direct laryngoscopy, fiberoptic bronchoscopy, or, worse, emergency tracheostomy.
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Regional anesthetic techniques for children have recently enjoyed a justified resurgence in popularity. Intraoperative blockade of the neuraxis, whether by the spinal or epidural route, provides excellent analgesia with minimal physiologic alteration and, with an indwelling catheter, can provide continuous pain relief for many days postoperatively. ⋯ Although some practitioners contend that a regional block on an already anesthetized child adds to the risk of the general anesthetic itself, in experienced hands the risks are negligible and the benefits dramatic. In this review of caudal and lumbar epidural and subarachnoid blockade in infants and children, anatomy, physiologic alterations, and pharmacology pertinent to the three types of neuraxial blockade are described, with the aim of providing the practicing anesthesiologist with the foundation needed to perform these blocks with relative confidence.
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Case Reports
General anesthesia for cesarean section in a parturient with a single ventricle and pulmonary atresia.
The successful management of a cesarean section in a parturient with a single ventricle and pulmonary atresia using general anesthesia is discussed. After cyanosis at birth, the patient underwent cardiac catheterization, which showed an apparent severe tetralogy of Fallot, atresia of the main pulmonary artery (PA), and a large patent ductus arteriosus. When she was 7 months of age, a Blalock-Taussig shunt (right subclavian artery to right PA) was done. ⋯ The patient was then taken to the operating room electively, and an opioid-based general anesthetic was administered. Both mother and infant did well. This case is presented because the physiology of the patient's lesion and her unusual social history presented challenges for her anesthetic management.
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To estimate the frequency of successful conduction blockade of the femoral, lateral femoral cutaneous, and obturator nerves following a femoral 3-in-1 block. ⋯ The femoral 3-in-1 nerve block does not block the parent trunk of the obturator nerve.
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To evaluate the success of epidural anesthesia for postpartum tubal ligation using epidural catheters placed during labor and to determine whether patient characteristics, timing of surgery, or technical factors (e.g., length of epidural catheter inserted into the epidural space) influenced the success of subsequent epidural anesthesia. ⋯ Although other factors may influence the timing of postpartum tubal ligation after delivery, the success of epidural anesthesia for tubal ligation using in situ epidural catheters is greater if surgery is performed shortly after delivery.