100% Nitrous Oxide in the Oxygen Line: How Could This Happen in a Modern Anesthesia Machine?

The inadvertent crossover between O2 and N2O pipelines has become extremely rare in practice. We describe a case where it was possible to ventilate with 100% N2O instead of the intended 100% O2 on a modern anesthesia delivery system (Dräger Apollo; Drägerwerk AG & Co KgaA, Lübeck, Germany). This was the result of the incorrect assembly of diameter index safety system (DISS) components during preventative maintenance that defeated the DISS failsafe system.

Feasibility study of a smartphone pupillometer and evaluation of its accuracy.

Measurement of pupillary characteristics, such as pupillary unrest in ambient light, and reflex dilation have been shown to be useful in a variety of clinical situations. Dedicated pupillometers typically capture images in the near-infrared to allow imaging in both light and darkness. However, because a subset of pupillary measurements can be acquired with levels of visible light suitable for conventional cameras, it is theoretically possible to capture data using general purpose cameras and computing devices such as those found on smartphones.

An Anesthesia Attempt to Be Green: How Do You Waste Your Carbon Dioxide Absorbers?

Operating room waste is categorized as noncontaminated solid waste (SW) and regulated medical waste (RMW). RMW is treated by autoclaving at an increased economic and environmental cost. We evaluated these costs with a focus on the disposable carbon dioxide (CO2) absorbers.

A novel thermal compression device for perioperative warming: a randomized trial for feasibility and efficacy.

Background: Inadvertent perioperative hypothermia (IPH) leads to surgical complications and increases length of stay. IPH rates are high with the current standard of care, forced air warming (FAW). Our hypothesis is that a prototype thermal compression device that heats the popliteal fossa and soles of the feet, with lower leg compression, increases perioperative temperatures and reduces IPH compared to the current standard of care.

Capnoperitoneum During Peroral Endoscopic Myotomy-Recognition and Management: A Case Report.

Peroral endoscopic myotomy (POEM) is a minimally invasive procedure for treating esophageal achalasia. During POEM, carbon dioxide is insufflated under pressure into the esophagus and stomach, which can cause clinically significant capnoperitoneum, capnomediastinum, or capnothorax. We present a case in which gas accumulation in the abdomen during POEM had adverse effects on ventilation.

A Case Illustrating the Costs of Quality Improvement: Nine Months to Move Needles and Syringes on the Anesthesia Cart.

Powerful entities are pushing physicians to become more involved with quality improvement (QI). We report a QI project to standardize and improve the ergonomics of the anesthesia medication and supply cart. Simply obtaining approval to make minor changes to the cart involved 54 phone calls, 164 e-mails, 4 presentations, 2 forms, 9 meetings, and 4 months of time.

Delayed emergence after anesthesia.

In most instances, delayed emergence from anesthesia is attributed to residual anesthetic or analgesic medications. However, delayed emergence can be secondary to unusual causes and present diagnostic dilemmas. Data from clinical studies is scarce and most available published material is comprised of case reports.

Risk factors for respiratory depression in patients undergoing retrobulbar block for vitreoretinal surgery.

Background And Objective: To determine the risk factors for respiratory depression during retrobulbar block administration before vitreoretinal surgery.

Patients And Methods: Prospective, observational case series of 113 patients undergoing monitored anesthesia care and retrobulbar block before vitreoretinal surgery at a tertiary medical center.

Results: Chin lift, jaw thrust, and bag mask ventilation were performed in eight (7.

Preliminary study of ergonomic behavior during simulated ultrasound-guided regional anesthesia using a head-mounted display.

A head-mounted display provides continuous real-time imaging within the practitioner's visual field. We evaluated the feasibility of using head-mounted display technology to improve ergonomics in ultrasound-guided regional anesthesia in a simulated environment. Two anesthesiologists performed an equal number of ultrasound-guided popliteal-sciatic nerve blocks using the head-mounted display on a porcine hindquarter, and an independent observer assessed each practitioner's ergonomics (eg, head turning, arching, eye movements, and needle manipulation) and the overall block quality based on the injectate spread around the target nerve for each procedure.

Human subthalamic neuron spiking exhibits subtle responses to sedatives.

Background: During deep brain stimulation implant surgery, microelectrode recordings are used to map the location of targeted neurons. The effects produced by propofol or remifentanil on discharge activity of subthalamic neurons were studied intraoperatively to determine whether they alter neuronal activity.

Methods: Microelectrode recordings from 11 neurons, each from individual patients, were discriminated and analyzed before and after administration of either propofol or remifentanil.