Clinical Anesthesia - Near Misses and Lessons Learned

di Brock Utne • 2008 • dettagli prodotto

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DESCRIZIONE

Although near-miss situations are fortunately rare in anesthesiology, it is essential to know how to respond if these situations arise. This collection of actual cases, compiled from the author’s thirty-five plus years of practice in major metropolitan hospitals in the United States, Norway, and South Africa, is an excellent review of potential problems and solutions all anesthesiologists should be familiar with. Succinct case presentations describe a problem and the solution, with each write-up concluded by a retrospective analysis examining whether the solution used was actually the best (or only) choice. Other solutions and equally satisfactory outcomes are explored, and tips to help avoid problems altogether are presented where possible. This book may therefore serve as either an excellent review for the American Board of Anesthesiology’s oral exam or as an easy and practical way for the reader to gain familiarity with unexpected problems in clinical anesthesia.Table of contents No fiberoptic intubation system: a potential problem?.- Is the patient extubated?.- A strange computerized ECG interpretation.- Fractured neck of femur in an elderly patient.- Spinal anesthetic that wears off before surgery ends.- Understanding DNR/DNI orders.- Burn prevention in the operating room.- Inguinal hernia repair in a diabetic patient.- Case of the hidden IV.- Ideal pulse oximeter placement.- Awake craniotomy with language mapping.- Gum elastic bougie to facilitate intubation.- External vaporizer leak during anesthesia.- Manual ventilation by a single operator: Omar’s slave for difficult positioning.- Life threatening arrhythmia in an infant.- Tongue ring: Anesthetic risks and potential complications.- Hasty C-arm positioning: A recipe for disaster.- Inability to remove a nasogastric tube.- An unusual cause of difficult tracheal intubation: Religious beliefs and customs.- Pulmonary edema following abdominal laparoscopy.- Difficult laryngeal mask airway placement: A possible solution.- Postoperative airway complication following sinus surgery.- Investigating an unusual capnograph tracing: Check your connections.- Endotracheal intubation for atransjugular intrahepatic porto-systemic shunt (TIPS) procedure.- Tracheostomy by an anesthesiologist: Be prepared.- General anesthesia for a patient with a difficult airway and a full stomach.- Jehovah’s Witness and a potentially bloody operation.- Intraoperative insufflation of the stomach.- Sudden intraoperative hypotension.- Overestimation of blood pressure from an arterial pressure line.- Severe decrease in lung compliance during a code blue.- Shortening postoperative recovery time after an epidural: Is it possible? .- Difficult airway in an under-equipped setting.- Delayed cutaneous fluid leak following removal of an epidural catheter.- Traumatic hemothorax and same-side central venous access.- An apparent single abdominal knife wound: Check for other wounds.- A draw-over vaporizer with a non-rebreathing circuit.- Unexpected intraoperative "oozing".- Central venous access and the obese patient.- Taking over for a colleague: Check the facts and know the medications.- Intraoperative epidural catheter malfunction.- Breathing difficulties after an ECT.- White clumps in the blood sample from an arterial line: Beware of heparin-induced thrombocytopenia.- Anesthesia for a surgeon who has previously lost his privileges.- Airway obstruction in a prone patient.- Expected length of case: A question you should always ask.- Postoperative vocal cord paralysis.- Substance abuse by a colleague: a serious problem.- A leaking endotracheal tube in a prone patient.- Lessons from the field: Unusual problems require unusual solutions in impossible situations.- Avoiding air embolism during administration of albumin.- Trouble-shooting leaks: A loud "pop" intraoperatively and now you can’t ventilate.- Postoperative median nerve injury.- Patient in a halo: Intraoperative adjustments change your view and access.- Now or never: Developing professional judgment.- General anesthesia in a patient with chronic amphetamine use.- What’s wrong with this picture? Left-handed instrumentation.- The one eyed patient.- A near tragedy.- Robot assisted surgery: a word of caution.- An airway mergency in an out of hospital surgical office.- Another use for the nerve stimulator