Clinical Anesthesia

by Brock-Utne, John G., M.D., Ph.D.

• ISBN13: 9780387725192
• ISBN10: 0387725199
• Edition: 1st
• Format: Paperback
• Copyright: 2007-11-07
• Publisher: Springer Verlag

Summary

Although near-miss situations are relatively rare in anesthesiology, it is essential to know how to respond if the situation arises. This collection of actual cases, compiled from the author's 30+ years practice in major metropolitan hospitals in the US, Sweden and South Africa, is an excellent review of potential problems and solutions all anesthesiologists should be familiar with. The cases are succinct, with the problem described on one page, the solution on the next, concluded by a retrospective analysis that examines whether the solution used was actually the best (or only) choice, or if other solutions might provide equally satisfactory outcomes. Also included in the analyses are tips to help avoid the problem altogether, when possible. This book is an excellent review for the ABA oral exam and is an easy and practical way to prepare for the unexpected in the daily practice of clinical anesthesia.

Author Biography

John Brock-Utne is currently a professor of Anesthesia and the Associate Director of the Anesthesia Residency Program at Stanford University Medical School.  He has written over 200 peer reviewed articles and 370 abstracts and letters, including the book Near Misses in Pediatric Anesthesia.

Table of Contents

Foreword	p. vii
Preface	p. ix
Acknowledgments	p. xi
No Fiberoptic Intubation System: A Potential Problem	p. 1
Is the Patient Extubated?	p. 3
A Strange Computerized Electrocardiogram Interpretation	p. 6
Fractured Neck of Femur in an Elderly Patient	p. 10
Spinal Anesthetic That Wears Off Before Surgery Ends	p. 12
Just a Simple Monitored Anesthesia Care Case	p. 14
Smell of Burning in the Operating Room	p. 17
Inguinal Hernia Repair in a Diabetic Patient	p. 19
The Case of the "Hidden" IV	p. 22
Postoperative Painful Eye	p. 24
Awake Craniotomy with Language Mapping	p. 26
Gum Elastic Bougie: Tips for Its Use	p. 28
External Vaporizer Leak During Anesthesia	p. 31
Manual Ventilation by a Single Operator: With Patient Turned 180 Degrees Away from the Anesthesia Machine	p. 33
Life-Threatening Arrhythmia in an Infant	p. 36
Tongue Ring: Anesthetic Risks and Potential Complications	p. 39
Hasty C-Arm Positioning: A Recipe for Disaster	p. 42
Inability to Remove a Nasogastric Tube	p. 44
An Unusual Cause of Difficult Tracheal Intubation	p. 46
Pulmonary Edema After Abdominal Laparoscopy	p. 48
Difficult Laryngeal Mask Airway Placement: A Possible Solution	p. 51
Postoperative Airway Complication After Sinus Surgery	p. 54
Investigating an Unusual Capnograph Tracing: Check Your Connections	p. 57
A Respiratory Dilemma During a Transjugular Intrahepatic Portosystemic Shunt Procedure	p. 60
A Tracheostomy Is Urgently Needed, but You Have Never Done One	p. 62
General Anesthesia for a Patient with a Difficult Airway and a Full Stomach	p. 65
Jehovah's Witness and a Potentially Bloody Operation	p. 68
Intraoperative Insufflation of the Stomach	p. 71
Sudden Intraoperative Hypotension	p. 73
Overestimation of Blood Pressure from an Arterial Pressure Line	p. 76
Severe Decrease in Lung Compliance During a Code Blue	p. 79
Shortening Postanesthesia Recovery Time After an Epidural: Is It Possible?	p. 82
Difficult Airway in an Underequipped Setting	p. 85
Delayed Cutaneous Fluid Leak After Removal of an Epidural Catheter	p. 87
Traumatic Hemothorax and Same-Side Central Venous Access	p. 90
Single Abdominal Knife Wound? Easy Case?	p. 93
A Draw-Over Vaporizer with a Nonrebreathing Circuit	p. 95
Unexpected Intraoperative "Oozing"	p. 98
Central Venous Access and the Obese Patient	p. 101
Taking Over for a Colleague: Always a Potential Concern	p. 104
Intraoperative Epidural Catheter Malfunction	p. 106
Breathing Difficulties After an Electroconvulsive Therapy	p. 109
White "Clumps" in the Blood Sample from an Arterial Line: Are You Concerned?	p. 112
Anesthesia for a Surgeon Who Has Previously Lost His Privileges	p. 115
Airway Obstruction in a Prone Patient	p. 117
A Question You Should Always Ask	p. 119
Postoperative Vocal Cord Paralysis	p. 121
A Serious Problem	p. 124
A Leaking Endotracheal Tube in a Prone Patient	p. 127
Lessons from the Field: Unusual Problems Require Unusual Solutions in Impossible Situations	p. 129
An "Old Trick" but a Potential Problem	p. 132
A Loud "Pop" Intraoperatively and Now You Cannot Ventilate	p. 134
Postoperative Median Nerve Injury	p. 136
A Patient in a Halo: Watch Out	p. 138
Now or Never: Developing Professional Judgment	p. 141
General Anesthesia in a Patient with Chronic Amphetamine Use	p. 143
What Is Wrong with This Picture?	p. 145
The One-Eyed Patient	p. 147
A Near Tragedy	p. 149
Robot-Assisted Surgery: A Word of Caution	p. 151
An Airway Emergency in an Out of Hospital Surgical Office	p. 153
Bonus Question: Is the Patient Paralyzed?	p. 155
Appendix	p. 157
Index	p. 159
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