Journal of clinical anesthesia
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To determine the consequences of esophageal intubation (EI) when using standard indirect clinical tests to detect endotracheal tube (ETT) placement in the emergency setting outside the operating room (OR). ⋯ These data suggest that EI during emergency intubation, when detected by standard indirect clinical tests based on physical examination, contributes significantly to mild and severe hypoxemia, regurgitation, aspiration, bradycardia, cardiac dysrhythmias, and cardiac arrest. Pursuing methods to hasten the detection of EI in the emergency setting appear warranted.
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Central venous cannulation, with or without a flow-directed pulmonary artery catheter, is commonly performed in patients undergoing cardiac surgery to measure central filling pressure and cardiac output, and to administer medications and fluids. The complications of central venous cannulation are numerous and include malposition, arterial puncture, pneumothorax, hemothorax, chylothorax, extravasation of infusate, thrombophlebitis, and infection. We describe a single-lumen catheter that was placed through the hemostatic valve of a 9F percutaneous introducer, which inadvertently entered the left internal mammary (internal thoracic) vein. The current case is unique in that it was diagnosed by visualization of the catheter during surgical dissection.
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To determine which patient parameters best predict left bronchial width (LBW) when selecting the correct size double-lumen tube (DLT). If LBW is known, a DLT that will fit that bronchus can be chosen. ⋯ Direct airway measurement is the most accurate way to select an appropriate DLT. However, when direct measurement of LBW cannot be performed, estimating LBW from TW is a better predictor of LBW than either sex, height, or weight.
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A 43-year-old man with neurofibromatosis and tracheal neurofibroma of the mid-trachea and respiratory difficulty was brought to the operating room for tracheostomy. After talking to the surgeons and viewing the computerized axial tomography, tracheal intubation was done under local anesthesia. Then, general anesthesia was provided for biopsy and debulking of the tumor, followed by tracheostomy. The patient had a number of surgeries later and the trachea was decannulated.
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Randomized Controlled Trial Clinical Trial
The number of injections does not influence absorption of bupivacaine after cervical plexus block for carotid endarterectomy.
To investigate the efficacy and kinetics of bupivacaine when used for deep cervical plexus block (CPB), using either a single-injection or multiple-injections technique. ⋯ The results of this study showed that the absorption of bupivacaine is independent of the number of injections after CPB, and that anesthesia for carotid endarterectomy may be accomplished successfully using either technique.