Journal of clinical anesthesia
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To determine the influence of profiling and incentives on anesthesiologist behavior in relation to several key indicators of performance. ⋯ Tracking and rewarding physician performance with monthly profiling and a financial incentive given to the best in a peer group improves anesthesiologist performance in several key areas.
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To determine the incidence and etiology of cardiopulmonary arrest during emergency intubation in the remote location by comparing two periods (1990-1995 vs. 1995-2002) at the same institution to assess whether immediate access to advanced airway devices and endotracheal tube-verifying devices altered the incidence of hypoxemia-driven cardiac arrest. ⋯ Cardiac arrest during emergency tracheal intubation outside the OR is relatively common compared with the OR environment. Airway-related complications played a prominent role, either singly or in combination with the patient's underlying physiological state. Immediate access to advanced airway devices and endotracheal tube-verifying devices appear to have a significant impact on the incidence of hypoxemia-driven cardiac arrest.
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Case Reports
Entrapment of pulmonary artery catheter in a suture at the inferior vena cava cannulation site.
Entrapment of a pulmonary artery catheter (Swan-Ganz catheter) in the heart, vena cava, or pulmonary artery is a very rare and serious complication that may lead to life-threatening complications such as cardiac rupture, pulmonary artery rupture, cardiac tamponade, among others, if not recognized and treated early. We report entrapment of a Swan-Ganz catheter in the purse-string suture at the inferior vena cava cannulation site for a patient undergoing aortic valve replacement. This situation required a repeat sternotomy to release the pulmonary artery catheter.
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A severe limb injury challenges an anesthesiologist's ability to provide care. We describe the difficulties encountered by an anesthesiology resident with a severely injured left arm and present solutions to overcoming an inability to perform traditional direct laryngoscopy. Airway management adjuncts explored include modified left-handed direct laryngoscopy, lighted stylet intubation, fiberoptic intubation, Laryngeal Mask Airway, Combitube, retrograde wire technique, and the eventual conversion to direct laryngoscopy with the right hand with the reversed Macintosh and the Cranwall modification of the Miller blade. The practical and social problems of a disability during residency are also discussed.