AANA journal
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Although anesthetists have long assumed that ketamine's role in neuroanesthesia is limited because of its association with increased intracranial pressure, this article presents a review of recent clinical literature suggesting otherwise. When ketamine is used as an adjuvant anesthetic agent along with mechanical ventilation to maintain normocapnia, ketamine does not have adverse cerebral hemodynamic effects. ⋯ Caution must be exercised because of ketamine's action at the N-methyl-D-aspartate receptor (NMDAR), as ketamine may antagonize both neuroprotective and neurodestructive NMDAR-mediated pathways. Still, ketamine may prove to be a safe part of a neuroanesthetic regimen, and it should no longer be considered absolutely contraindicated as a result of its cerebral hemodynamic effects.
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Randomized Controlled Trial Comparative Study
Ease of intubation with the Parker Flex-Tip or a standard Mallinckrodt endotracheal tube using a video laryngoscope (GlideScope).
Two endotracheal tubes (ETTs) are available for use in operative suites for intubation: the Parker Flex-Tip (PFT, Parker Medical) and the standard Mallinckrodt (Covidien). To the authors' knowledge, no study has compared these 2 ETTs with each other when the anesthesia provider uses the GlideScope video laryngoscope (Verathon) for intubation. The purpose of the study was to determine if there are differences related to ease of intubation reported by anesthesia providers who use the PFT tube compared with the standard tube while using the GlideScope. ⋯ The PFT tube in suboptimal conditions demonstrated a significantly greater ease of intubation, as measured by decreased time for ETT insertion and greater ease of ETT insertion score. The number of redirections at the glottis to intubate the trachea once the glottis was visualized was not statistically different. Based on the findings from this study, anesthesia providers may want to consider the use of the PFT tube when using the GlideScope to promote ease of intubation.
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Case Reports
Awake video laryngoscope intubation: case report of a patient with a nasopharyngeal mass.
Difficult airway management remains central to anesthesia practice. Video laryngoscopes have been an adjunct to airway management since the early 2000s. ⋯ The purpose of this article is to summarize the use of a video laryngoscope for an awake intubation and to suggest alternative uses of these devices in other awake intubation scenarios. The case report presented offers a description of successful awake intubation using a video laryngoscope in a patient with a large pedunculated mass arising from the nasopharynx and extending down into the oropharynx.