Articles: cations.
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We present a case of a 63-year-old man with nasocutaneous fistula located outside the area covered by a large adult facemask. The patient was uncooperative for the standard airway assessment and any attempt at awake intubation. ⋯ Although the incidence of overall complications, including fistula formation, following free flap reconstruction for oropharyngeal cancer is reported as high as 20%, few case reports detailing airway management exist. We demonstrate that it is possible to use conventional techniques to induce and ventilate a patient with a large, externalized, airway fistula by covering the defect with an occlusive transparent dressing.
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Sternotomy pain is a common complication after cardiac surgery. We present a 77-year-old patient with severe acute sternal pain after coronary artery bypass graft surgery who was successfully treated with a novel peripheral regional anesthetic technique, the pecto-intercostal fascial block. This interfascial plane block may represent an effective regional anesthetic component of a multimodal analgesic strategy for cardiac surgery patients who suffer from significant pain after a median sternotomy and are typically anticoagulated.
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Randomized Controlled Trial Multicenter Study
Randomized clinical trial of the effect of a fibrin sealant patch on pancreatic fistula formation after pancreatoduodenectomy.
The potential for a fibrin sealant patch to reduce the risk of postoperative pancreatic fistula (POPF) remains uncertain. The aim of this study was to evaluate whether a fibrin sealant patch is able to reduce POPF in patients undergoing pancreatoduodenectomy with pancreatojejunostomy. ⋯ The use of a fibrin sealant patch did not reduce the occurrence of POPF and complications after pancreatoduodenectomy with pancreatojejunostomy. Registration number: 2013-000639-29 (EudraCT register).
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Anesthesia and analgesia · Jun 2018
ReviewWorld Health Organization-World Federation of Societies of Anaesthesiologists (WHO-WFSA) International Standards for a Safe Practice of Anesthesia.
The International Standards for a Safe Practice of Anesthesia were developed on behalf of the World Federation of Societies of Anaesthesiologists (WFSA), a nonprofit organization representing anesthesiologists in 150 countries, and the World Health Organization (WHO). The recommendations have been approved by WHO and the membership of WFSA. These Standards are applicable to all anesthesia providers throughout the world. ⋯ The Standards cover professional aspects; facilities and equipment; medications and intravenous fluids; monitoring; and the conduct of anesthesia. HIGHLY RECOMMENDED standards, the functional equivalent of mandatory standards, include (amongst other things): the continuous presence of a trained and vigilant anesthesia provider; continuous monitoring of tissue oxygenation and perfusion by clinical observation and a pulse oximeter; intermittent monitoring of blood pressure; confirmation of correct placement of an endotracheal tube (if used) by auscultation and carbon dioxide detection; the use of the WHO Safe Surgery Checklist; and a system for transfer of care at the end of an anesthetic. The International Standards represent minimum standards and the goal should always be to practice to the highest possible standards, preferably exceeding the standards outlined in this document.