AANA journal
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Our anesthesia care team was called to care for a patient who was admitted to the emergency department with the esophageal-tracheal double-lumen airway device (Combitube, Tyco Healthcare, Nellcor, Pleasanton, California) in place, which needed to be exchanged for a definitive airway because the patient required an extended period of mechanical ventilation. Several techniques were attempted to exchange the esophageal-tracheal Combitube (ETC) without success. First, we attempted direct laryngoscopy with the ETC in place after deflation of the No. 1 proximal cuff and sweeping the ETC to the left. ⋯ Before proceeding with cricothyrotomy, we repeated direct laryngoscopy but without the ETC in place. We identified the tip of the epiglottis, which allowed for bougie-assisted intubation. This obviated the need for emergency cricothyrotomy.
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Review Case Reports
Myocardial infarction and subsequent death in a patient undergoing robotic prostatectomy.
A 52-year-old patient, ASA physical status IV, undergoing a radical prostatectomy for cancer with a robotic system had a cardiac arrest 3 hours into the case. All attempts to resuscitate were unsuccessful, and several hours later he was pronounced dead. Underlying patient comorbidity and procedural issues contributed to the patient's death. ⋯ The needed positioning, combined with the problems associated with insufflation, presents a unique challenge in anesthetic management. This course reviews the current literature on the surgical implications for patients with drug-eluting stents and the physiologic factors related to position and pneumoperitoneum and their associated stressors. By using a review of the contemporary literature, a best-evidence approach to anesthetic management is reviewed.
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Comparative Study
Attitudes toward physician-nurse collaboration in anesthesia.
The purpose of this study was to compare the attitudes of anesthesiologists and nurse anesthetists toward collaboration with each other. Data for this descriptive, comparative study were gathered through a mailed survey to 501 nurse anesthetists and 353 anesthesiologists licensed to practice in 7 state of the United States. Attitude toward collaboration was measured using an adaptation of the Jefferson Scale of Attitudes Toward Physician-Nurse Collaboration. ⋯ Additional analyses failed to show a significant difference based on sexual gender. The results of this study provide some evidence that the divergent perspectives regarding collaboration previously demonstrated between physicians and nurses may also exist in the specialty field of anesthesia. This study provided no support for the supposition that gender contributes to the differences in attitude toward collaboration between physicians and nurses.
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Case Reports
Intraosseous infusion of blood products and epinephrine in an adult patient in hemorrhagic shock.
A 79-year-old woman presented in the postanesthesia care unit with hematemesis following replacement of a jejunostomy tube. Her medical history included recurrent stage IIIC ovarian cancer. The patient rapidly decompensated despite blood products administered through the patient's implanted medication port. ⋯ Hemostasis was achieved, and the patient was admitted to the intensive care unit. Intraosseous infusion is a valuable and underutilized technique in managing patients in hemorrhagic shock with poor IV access. Anesthesia providers should seek education and training from those experienced in IO placement techniques and consider use of the IO route early in the resuscitative process.
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Review Case Reports
Anesthetic management of an obstetric patient with Charcot-Marie-Tooth disease: a case study.
Additional documentation of regional anesthesia in patients with Charcot-Marie-Tooth disease (CMT) is needed to guide practitioners and patients in exploring appropriate options for anesthesia and analgesia management. This case report describes the successful use of a combined spinal-epidural technique for labor progressing to cesarean delivery in a patient with CMT. ⋯ This case report confirms what seems to be the developing consensus in anesthesia that regional management is a safe alternative to general anesthesia in these patients. Considering that CMT is among the most common of hereditary neuromuscular diseases, it seems valid to establish a more research-driven recommendation for practice.