Journal of clinical anesthesia
-
Postoperative airway compromise due to laryngopharyngeal edema is a potentially serious adverse event associated with anterior cervical spine surgery. The reported incidence of this complication has varied from 1.2% to 6.1%, with a higher incidence following multi-level surgery. The relevant literature on airway compromise following anterior cervical spine surgery is reviewed.
-
Review Case Reports
Severe hypothyroidism presenting as myxedema coma in the postoperative period in a patient taking sunitinib: case report and review of literature.
The case of a 62-year-old Caucasian woman who underwent urgent hip hemiarthroplasty for repair of a pathological fracture is reported. The patient's medical history was significant for renal cell carcinoma, cerebellar metastases, and sunitinib-induced hypothyroidism. Her intraoperative course was complicated by profound hypothermia, bradycardia, augmentation of neuromuscular blockade, delayed emergence, failure of postoperative extubation, and need for mechanical ventilation. The intensive care course was significant for hypothermia requiring forced-air warming, treatment with intravenous thyroxine (T4), and hemodynamic supportive care.
-
Review Case Reports
Intraoperative hypercyanosis in a patient with pulmonary artery band: case report and review of the literature.
A case of intraoperative cyanosis in a patient with a common atrioventricular canal palliated with a pulmonary artery (PA) band is presented. The patient's physiology was consistent with cyanosis due to inadequate pulmonary blood flow, and responded quickly to typical interventions used for a hypercyanotic episode in a patient with unrepaired Tetralogy of Fallot. Differences and similarities in the physiology of PA banding compared with Tetralogy of Fallot are presented, including a rationale for treatment options for hemodynamic decompensation occurring in the setting of anesthesia and surgery.
-
Review Comparative Study
Comprehensive review: is it better to use the Trendelenburg position or passive leg raising for the initial treatment of hypovolemia?
Hypovolemia is a common clinical problem. The Trendelenburg position and passive leg raising (PLR) are routinely used in the initial treatment while awaiting fluid resuscitation. In this meta-analysis, we evaluated the hemodynamic effects of PLR and Trendelenburg positioning to determine which position had the most optimal effect on cardiac output (CO). ⋯ The effect persisted after this period by 6%, or 0.17 L/min. Both Trendelenburg and PLR significantly increased CO, but only PLR seemed to sustain this effect after one minute. Although the Trendelenberg position is a common maneuver for nurses and doctors, PLR may be the better intervention in the initial treatment of hypovolemia.
-
To evaluate the outcome of airway management in patients with complex maxillofacial fracture by submental intubation, time required for intubation, accidental extubation, and postoperative complications. ⋯ Submental endotracheal intubation is a simple technique with very low morbidity, and may be used as an alternative to tracheostomy in selected cases of maxillofacial trauma.