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Anesthesia case scenario

Robert L Ohsfeldt, Thomas R Miller, John E Schneider, Cara M Scheibling
STUDY OBJECTIVE: To provide estimates of the costs and health outcomes implications of the excess risk of unexpected disposition for nurse anesthetist (NA) procedures. DESIGN: A projection model was used to apply estimates of costs and health outcomes associated with the excess risk of unexpected disposition for NAs reported in a recent study. SETTING: Ambulatory and inpatient surgery. PATIENTS: Base-case model parameters were based on estimates taken from peer-reviewed publications when available, or from other sources including data for all hospital stays in the United States in 2013 from the Healthcare Cost and Utilization Project Web site...
December 2016: Journal of Clinical Anesthesia
Adam Meeney, Mathew Raynor, Matthew Edwards, Hardeep Singh Mudhar
PURPOSE: To describe the clinical, imaging, and histopathological features of a highly unusual, postcontact lens removal scenario in a 29-year-old woman. Most documented cases recover good vision but differ significantly from our case. METHODS: A 29-year-old woman presented to the Eye Casualty Department as she was unable to remove her right soft contact lens after having inadvertently slept wearing soft contact lenses. During removal, extensive axial corneal epithelial sloughing occurred...
October 2016: Cornea
Arvind Badhey, Sameep Kadakia, Manoj T Abraham, J K Rasamny, Augustine Moscatello
Reconstruction of the scalp following oncologic resection is a challenging undertaking owing to the variable elasticity of the soft tissue overlying the calvarium and the limited amount of tissue available for recruitment. Defect size, location, and skin characteristics heavily influence the reconstructive options available to the surgeon. Reconstruction options for scalp defects range from simple direct closure, to skin grafting, to adjacent tissue transfer with local flaps, and ultimately to free tissue transfer...
September 2016: American Journal of Otolaryngology
Ayman Ads, Frederic Auerbach, Kelly Ryan, Abdel R El-Ganzouri
We report the successful use of the Air-Q laryngeal airway (Air-Q LA) as a ventilatory device and a conduit for tracheal intubation to rescue the airway in a patient with difficult airway and tracheal stenosis. This is the first case report of the device to secure the airway after two episodes of hypoxemia in the operating room and intensive care unit. Consent for submission of this case report was obtained from our institution's human studies institutional review board given that the patient died a few months after his discharge from the hospital before his personal consent could be obtained and before preparation of this report...
August 2016: Journal of Clinical Anesthesia
Massimiliano Sorbello, Giulio Frova, Ivana Zdravković
Airway management is basic for anesthesia practice, and sometimes it can represent a really dramatic scenario for both the patient and the physicians. Laryngoscopy has been the gold standard of airway visualization for more than 60 years, showing its limitations and failure rates with time. New technology has made available an opportunity to move the physician's eye inside patient airways thanks to video laryngoscopy and video assisted airway management technique. Undoubtedly, we have entered a new era of high resolution airway visualization and different approach in airway instrumentation...
March 2016: Acta Clinica Croatica
Liam O'Neill, Franklin Dexter, Nan Zhang
In this article, we consider the privacy implications of posting data from small, randomized trials, observational studies, or case series in anesthesia from a few (e.g., 1-3) hospitals. Prior to publishing such data as supplemental digital content, the authors remove attributes that could be used to re-identify individuals, a process known as "anonymization." Posting health information that has been properly "de-identified" is assumed to pose no risks to patient privacy. Yet, computer scientists have demonstrated that this assumption is flawed...
June 2016: Anesthesia and Analgesia
Kohji Uzawa, Joho Tokumine, Alan Kawarai Lefor, Toshiyuki Takagi, Kunitaro Watanabe, Tomoko Yorozu
The "cannot ventilate, cannot intubate" scenario during anesthesia induction can be lethal. We present a patient with an undiagnosed subglottic tumor who developed the "cannot ventilate, cannot intubate" situation after induction of general anesthesia, due to the presence of an undiagnosed subglottic tumor. A 93-year-old woman was brought to the operating room for repair of a femoral neck fracture. Both ventilation and intubation could not be accomplished, and the patient was awakened without complications after trials of maintaining the airway...
April 2016: Medicine (Baltimore)
Ana Mavarez-Martinez, Suren Soghomonyan, Gurneet Sandhu, Demicha Rankin
Many trauma patients present with a combination of cranial and thoracic injury. Anesthesia for these patients carries the risk of intraoperative hemodynamic instability and respiratory complications during mechanical ventilation. Massive air leakage through a lacerated lung will result in inadequate ventilation and hypoxemia and, if left undiagnosed, may significantly compromise the hemodynamic function and create a life-threatening situation. Even though these complications are more characteristic for the early phase of trauma management, in some cases, such a scenario may develop even months after the initial trauma...
January 2016: Journal of Investigative Medicine High Impact Case Reports
Shobana Rajan, Ashish Khanna, Maged Argalious, Stephen J Kimatian, Edward J Mascha, Natalya Makarova, Eman M Nada, Hesham Elsharkawy, Farhad Firoozbakhsh, Rafi Avitsian
STUDY OBJECTIVE: Simulation-based learning is emerging as an alternative educational tool in this era of a relative shortfall of teaching anesthesiologists. The objective of the study is to assess whether screen-based (interactive computer simulated) case scenarios are more effective than problem-based learning discussions (PBLDs) in improving test scores 4 and 8 weeks after these interventions in anesthesia residents during their first neuroanesthesia rotation. DESIGN: Prospective, nonblinded quasi-crossover study...
February 2016: Journal of Clinical Anesthesia
Thomas Rolf Erdmann, Jorge Hamilton Soares Garcia, Marcos Lázaro Loureiro, Marcelo Petruccelli Monteiro, Guilherme Muriano Brunharo
INTRODUCTION: Anesthesiology is the only medical specialty that prescribes, dilutes, and administers drugs without conferral by another professional. Adding to the high frequency of drug administration, a propitious scenario to errors is created. OBJECTIVE: Access the prevalence of drug administration errors during anesthesia among anesthesiologists from Santa Catarina, the circumstances in which they occurred, and possible associated factors. MATERIALS AND METHODS: An electronic questionnaire was sent to all anesthesiologists from Sociedade de Anestesiologia do Estado de Santa Catarina, with direct or multiple choice questions on responder demographics and anesthesia practice profile; prevalence of errors, type and consequence of error; and factors that may have contributed to the errors...
January 2016: Brazilian Journal of Anesthesiology
Alexandre Joosten, Olivier Desebbe, Koichi Suehiro, Mfonobong Essiet, Brenton Alexander, Cameron Ricks, Joseph Rinehart, David Faraoni, Maurizio Cecconi, Philippe Van der Linden, Maxime Cannesson
To assess the relationship between the addition of advanced monitoring variables and changes in clinical decision-making. A 15-questions survey was anonymously emailed to international experts and physician members of five anesthesia societies which focused on assessing treatment decisions of clinicians during three realistic clinical scenarios measured at two distinct time points. The first is when typical case information and basic monitoring (T1) were provided, and then once again after the addition of advanced monitoring variables (T2)...
December 19, 2015: Journal of Clinical Monitoring and Computing
Antonio Maria Dell'Anna, Domenico Luca Grieco, Andrea Russo, Elisabetta Marana, Massimo Antonelli
Effective treatment for many congenital heart diseases diagnosed before birth has become available since the last three decades. Continuous improvements in surgical knowledge and techniques have allowed patients born with severe heart defects to survive through adulthood. However, palliative surgery often implies profound modifications of classical circulatory physiology, which must be taken into account particularly when general anesthesia is needed for major noncardiac surgery. Among the palliative surgeries, Fontan repair is an intervention aiming at excluding the right heart chambers with a total cavopulmonary conduit, which directs blood flow from both inferior and superior vena cavae directly to the right pulmonary artery...
February 2016: Anesthesiology
Aya Yoshidome, Ayako Shinomiya, Tamao Iwagaki, Haruhiko Sano, Kazuyoshi Aoyama, Yukari Takenaka, Ichiro Takenaka
BACKGROUND: A previously healthy 54-year-old woman underwent a resection of the acoustic tumor. Following induction of general anesthesia and tracheal intubation, volume-controlled ventilation was started and the patient was placed in the left park bench position. The heat and moisture exchange filter (HMEF) was placed within the ventilatory circuit and positioned below the patient's head to avoid unintentional extubation. Six hours after the start of surgery, peak inspiratory pressure gradually rose, and 2 hours later ventilation of the patient's lung became increasingly difficult...
August 2015: Masui. the Japanese Journal of Anesthesiology
N Girish Kumar, H Rangarajan, Pankaj Shourie
UNLABELLED: Decompressive craniectomy is the most common neurosurgical procedure performed in today's scenario, usually posttrauma or a cerebrovascular event. Cranioplasty is the repair of a cranial defect or deformation. In the last decade, there has been an increase in the number of cranioplasties performed because of an increase in the number of decompressive craniectomies. Although the main purpose of cranioplasty is to protect the brain and restore aesthetics, it has been proved beyond doubt that there is also an improvement in function and patient self-esteem...
September 2015: Journal of Craniofacial Surgery
Annalisa Capuano, Maria Giuseppa Sullo, Concetta Rafaniello, Liberata Sportiello, Pierfrancesco Fusco, Macella De Vizia, Fausto Ferraro
Rocuronium is a non-depolarizing neuromuscular blocking agent (NDNMBA), employed in the clinic as an adjunct to general anesthesia to facilitate tracheal intubation rapid sequence, and to provide skeletal muscle relaxation during surgery. Many cases of resistance to neuromuscular blocking agents (NMBAs) have been anecdotally reported. There are specific pathologic states, such as upper motor neuron lesions, severe thermal injuries, liver disease, renal failure, disuse atrophy, all of which show an increased resistance to the effects of nondepolarizing muscle relaxants...
July 2015: Journal of Pharmacology & Pharmacotherapeutics
Robert Susło, Jakub Trnka, Jacek Siewiera, Jarosław Drobnik
In the Nordic mythology a man lost his ability to breathe without remembering it after he was cursed by water nymph - referred to as 'Ondine's curse' - and then he died as soon as he fell asleep. Family medicine specialists are familiar with many sleeping disorders that their patients commonly call by the term Ondine's Curse. In medical sciences this term is historically related to the group of conditions that have as the common denominator seemingly spontaneous onset of life-threatening hypoventilation. The physiology and genetics specialists focus mainly on congenital central hypoventilation syndrome (CCHS), which was proven to be linked to several genetic mutations...
2015: Advances in Experimental Medicine and Biology
Mysore Sujay, Santpur Madhavi, G Aravind, Adil Hasan, V M Venugopalan
Regional anesthesia is preferred world-wide for its distinct advantages. The benefits of regional anesthesia in patients with comorbid conditions are well-established. The administration of regional anesthesia can sometimes pose a challenge to the anesthesiologist due to the structural abnormalities of the spine. The most common difficulty encountered for spinal anesthesia in our hospital (Nalgonda District) is skeletal fluorosis. Apart from the midline approach, paramedian, and Taylor's approaches are advocated for difficult scenarios...
May 2014: Anesthesia, Essays and Researches
M Dylan Bould, Stephanie Sutherland, Devin T Sydor, Viren Naik, Zeev Friedman
PURPOSE: Our aim was to clarify how hierarchy influences residents' reluctance to challenge authority with respect to clearly erroneous medical decision-making. METHODS: After research ethics approval, we recruited 44 anesthesia residents for a high-fidelity simulation scenario at two Ontario universities. During the scenario, an actor, whom the residents were told was an actual new staff anesthesiologist at their university, asked the trainees to give blood to a Jehovah's Witness in contradiction to the patient's explicitly stated wishes...
June 2015: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Bryan Donald Laliberte, Emily Goldenberg, Sarah J Reece-Stremtan
Thyroid storm, a severe complication of hyperthyroidism, can be a devastating medical emergency requiring rapid management. Intraoperative thyrotoxicosis, a hypermetabolic syndrome with increased thyroid hormone levels, also presents a challenging scenario. Clinical suspicion is key along with eliminating other potentially catastrophic emergencies such as malignant hyperthermia or pheochromocytoma. In this case report, we describe a 15-year-old male undergoing halo traction placement for displaced dens and C1 fractures...
October 15, 2014: A & A Case Reports
Geetanjali Chilkoti, Rachna Wadhwa, Ashok Kumar
BACKGROUND: Anesthesia is a specialized branch of medicine with a very narrow margin of error. Incorporation of problem-based learning (PBL) in anesthesia post-graduate (PG) teaching enhances the critical thinking and problem-solving skills. It also helps in developing a broader prospective of clinical case scenarios. Case based discussions (CBD) are most widely practiced out of all PBL methods in anesthesia PG teaching. MATERIALS AND METHODS: We conducted an anonymous questionnaire based, cross-sectional survey among 62 anesthesia residents from various medical institutions in a city of Delhi, India...
January 2015: Saudi Journal of Anaesthesia
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