Indian journal of anaesthesia
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Postoperative diaphragmatic hernia following transhiatal oesophagectomy is a rare but potentially life threatening complication. We describe a case of a 65 year old patient who developed diaphragmatic hernia following oesophagectomy and presented with cardio pulmonary compromise. During surgery, haemodynamic instability continued despite fluid resuscitation and noradrenaline infusion. ⋯ This can be explained by tension colothorax causing collapse of the underlying lung and cardiac tamponade. It is a surgical emergency requiring urgent decompression for resuscitation. The etiology, clinical presentation, pathophysiology and preventive measures are discussed.
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Ineffective face mask seal is the most common cause for suboptimal pre-oxygenation. Room air entrainment can be more with vital capacity (VC) breaths when the mask is not a tight fit. ⋯ TV breathing for 5 min provides better pre-oxygenation in patients with ineffective mask seal with fresh gas flow of 10 L/min delivered through a circle system.
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Recent manuscripts have described the use of ultrasound imaging to evaluate airway structures. Ultrasound training tools are necessary for practitioners to become proficient at obtaining and interpreting images. Few training tools exist and those that do can often times be expensive and rendered useless with repeated needle passes. ⋯ The gel phantom model mimics human airway anatomy and may be used for ultrasound-guided airway assessment and intervention training. This may have important safety implications as ultrasound imaging is increasingly used for airway assessment.