AANA journal
-
Diastrophic dwarfism is an autosomal recessive disease that predominantly occurs in the Finnish population (1 in 33,000) but has been known to occur worldwide. Affected patients present with multiple cartilaginous anomalies and early degeneration of weight-bearing joints. Once past infancy, life expectancy is favorable and patients may undergo multiple surgical procedures throughout their lifetime to repair .or replace affected joints. The characteristic short trunk of these patients in addition to scoliosis, cervical kyphosis, and involvement of articular cartilages can create unique ventilation and airway challenges for anesthesia providers involved in their care.
-
Local anesthetic toxicity remains a clinical concern when performing regional anesthesia. Because signs and symptoms of toxicity may not appear for 20 to 30 minutes after administration of local anesthetic, vigilance is crucial. ⋯ The number of case reports demonstrating successful use of lipid emulsions is growing. Continued research remains pivotal to improve understanding of the theory of lipid emulsion pharmacology and application to clinical practice.
-
Case Reports
Anesthetic management for lobectomy in a patient with coccidioidomycosis: a case report.
Coccidioidomycosis is a fungal disease with a wide variety of manifestations. The systemic infection is a product of airborne spore inhalation released from the soil. This once-endemic disease is steadily increasing in incidence, geographic location, and severity. ⋯ This case report describes a 45-year-old woman with no relevant medical history admitted for lobec-occidi tomy with decortication because of aggressive coccidioidomycosis. Anesthetic considerations included attention to fungal sepsis, acute tubular necrosis related to amphotericin B therapy, and airway challenges. Careful attention to perioperative fungal therapies, invasive monitoring, and electrolyte stabilization remain pivotal concerns offering the best outcomes for patients with coccidioidomycosis.
-
The use of ultrasound as an adjunct to invasive anesthesia procedures is becoming commonplace. The U. S. ⋯ Human tissue is also an important factor in ultrasound imaging. The different densities of soft tissues, bone, fluid, and air all interact with sound, creating distinctive images that can aid and potentially hinder accuracy. Comprehension of basic ultrasound principles and how it is affected by tissue will enable anesthetists to better understand what is being seen and reduce the potential for errors.
-
Patients who are Jehovah's Witnesses refuse blood transfusions and blood products as a matter of faith. For surgical procedures during which substantial blood loss is possible, their refusal presents a challenge. 'Anesthetists must generally respect the requests of adults not to receive blood and thus should have a clear understanding of how they will respond in the event of bleeding. Several blood conservation techniques are available for consideration, including acute normovolemic hemodilution. ⋯ Leaving the procured blood continuously attached to the patient through the collection tubing makes the procedure acceptable to most Jehovah's Witness patients. Current literature is unclear when this technique should be used. In this particular case, acute normovolemic hemodilution contributed to the successful outcome of an anemic Jehovah's Witness who was undergoing major surgery.