Journal of clinical anesthesia
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We report an anaphylactoid reaction to etomidate twice in a 60-year-old male with coronary artery disease and peripheral vascular disease. Following the first anaphylactoid reaction, the patient developed myocardial infarction. ⋯ The patient did not manifest similar reaction to other induction drugs used for other surgeries. The patient recovered from both incidents of anaphylactoid reaction to etomidate following intravenous administration of epinephrine and fluids.
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We describe two cases of flash fires in the oropharynx, secondary to electrocautery during adenotonsillectomies. We believe that in both cases, the leak around the uncuffed endotracheal tubes raised the oxygen concentration in the oropharynx. Cuffed endotracheal tubes provide many advantages, and their use should strongly be considered during adenotonsillectomy in children when electrocautery is to be used.
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Comparative Study
Acquisition of basic fiberoptic intubation skills with a virtual reality airway simulator.
To test the hypothesis that a virtual reality (VR) airway simulator (the AccuTouch Virtual Reality Bronchsocopy Simulator; Immersion Medical, Gaithersburg, MD) can be used to teach residents basic fiberoptic intubation (FOI) skills effectively. ⋯ Use of a VR airway simulator enables anesthesia residents to acquire basic FOI skills comparable to those of experienced anesthesiologists in a human cadaver.
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Case Reports
Remifentanil-nitroglycerin combination as an anesthetic support for ex utero intrapartum treatment (EXIT) procedure.
A 21 year old healthy parturient was diagnosed as having a fetus with micrognathia. She was scheduled for an ex-utero intrapartum treatment (EXIT) procedure. General anesthesia consisted of remifentanil, nitrous oxide, and midazolam. ⋯ This technique offered hemodynamic stability and provided uterine relaxation that may be rapidly terminated. For the fetus, it provided excellent transplacental anesthesia. Supplemental direct fetal anesthesia is recommended to prevent the rapid decline of analgesia/anesthesia that occurs after placental separation.
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We report a case of general anesthesia for transurethral resection of the bladder in a 74-year-old male patient with uncorrected tetralogy of Fallot. This case illustrates the pertinent pathophysiology of the complex cardiac lesion related to tetralogy of Fallot as well as the feasibility and issues with regard to the anesthetic management.