A & A case reports
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Much waste arises from operating rooms (ORs). We estimated the practical and financial feasibility of an OR recycling program, weighing all waste from 6 ORs in Melbourne, Australia. Over 1 week, 237 operations produced 1265 kg in total: general waste 570 kg (45%), infectious waste 410 kg (32%), and recyclables 285 kg (23%). ⋯ The achieved recycling/potential recycling rate was 285 kg/517 kg (55%). The average waste disposal costs were similar for general waste and recycling. OR recycling rates of 20%-25% total waste were achievable without compromising infection control or financial constraints.
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Recently, we analyzed data from the American Society of Anesthesiologist's (ASA) Anesthesia Quality Institute (AQI) to report the United States (U. S.) anesthesia workload by time of day and day of the week. The AQI data were reported using the Central Time zone. ⋯ Weekends accounted for 15.3% ± 1.5% of MH Hotline calls, significantly greater than the rates of 5.2% of anesthesia minutes and 4.3% of general anesthesia minutes during weekends nationally (both P < 0.0001). Thus, the MH Hotline was used proportionately more often when anesthesia providers have fewer colleagues present and available for consultation (all P < 0.0001). These findings may be expected of other (future) national support centers for anesthesia.
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Persistent airway obstruction symptoms in a 2½-year-old boy with Pfeiffer syndrome were attributed to facial abnormalities, central and obstructive sleep apnea, and tracheomalacia from a vascular ring. These findings delayed the diagnosis of a tracheal cartilaginous sleeve. Life expectancy in tracheal cartilaginous sleeve is improved by tracheostomy. Tracheal cartilaginous sleeve should be considered and investigated through airway endoscopy in children with fibroblast growth factor receptor-related craniosynostosis syndromes.
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A healthy, active duty military 25-year-old female with a history of congenital complete heart block presented for a routine septorhinoplasty. During the preoperative interview, she did not disclose her heart condition. ⋯ During induction of anesthesia, she became extremely bradycardic, approaching asystole, requiring resuscitation. This case highlights the potential anesthetic risks in individuals with a history of congenital heart rhythm disease.
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A 72-year-old patient with an acute traumatic Type III odontoid fracture presented to the operating room for an urgent orthopedic procedure with a history of uncontrolled gastroesophageal reflux, a full stomach, and active vomiting. Rather than fiberoptic intubation, a rapid sequence intubation with manual inline stabilization was performed using a videolaryngoscope. A lateral cervical spine radiograph immediately after intubation showed no change in alignment of the fracture of C1-C2. In the presence of cervical spine instability, a postintubation radiograph provides assurance that the cervical spine is appropriately aligned during subsequent surgery.