General anesthesia complicated by perioperative iatrogenic splenic rupture.

Patients with splenomegaly often present with diverse coexisting medical disease and thus offer a variety of anesthetic considerations. The challenges that come with splenectomy have also become increasingly common to the anesthesiologist, given the growing number of indications for surgical intervention including both benign and malignant disease. Removal of the spleen is associated with numerous intraoperative and postoperative risks, including massive intraoperative hemorrhage, perioperative coagulation abnormalities, and post-splenectomy infection.

An unexpected needlestick injury.

Needle stick injuries occur at a significant rate. According to the National Institute for Occupational Safety and Health, there are approximately 600,000 to 800,000 needlestick and other percutaneous injuries every year among healthcare workers. Not only do the needlestick injuries put workers at risk for blood borne pathogens, but they cause a significant psychological and emotional burden for those involved.

General anesthesia for a patient with Brugada syndrome.

Brugada Syndrome is a genetic cardiac disease characterized by electrocardiogram changes consisting of an incomplete right bundle branch block, and ST-segment elevations in right precordial leads V1-V3. These patients are at high risk for developing spontaneous arrhythmias that can be fatal. Many factors during general anesthesia, such as medications, temperature changes, and heart rate variations, could precipitate lethal arrhythmias in this patient population.

The administration of general anesthesia to a patient with croup.

Croup in a young child may lead to severe airway narrowing, and would present a severe risk for administration of anesthesia. To the best of our knowledge, there have been no previous case reports of patients undergoing general anesthesia with croup. In our report, we describe a case of a 31 month old child with croup who required anesthesia.

Extreme intraoperative hyperkalemia in a non dialysis patient undergoing kidney transplantation.

The majority of patients who present for kidney transplantation have end stage renal disease and are on dialysis. Those patients are known to be at risk for the development of hyperkalemia. A patient who has not required dialysis, and with stable potassium levels would not be expected to acutely develop intraoperative hyperkalemia.

Missed steps in the preanesthetic set-up.

Background: Anesthesiologists accomplish many tasks rapidly during induction of an anesthetic. Key preparation for induction is needed to maximize patient safety. Given the intense environment of the operating room, preparatory steps may be missed either unintentionally or possibly even intentionally to save time.

Production pressure, medical errors, and the pre-anesthesia checkout.

Medical errors have rightly become an important societal and professional issue. While anesthesiology as a specialty has been at the forefront of the patient safety movement it is also subject to the same pressures for efficiency as any other business. Whether this pressure is at odds with the delivery of safe care is not yet clearly delineated.

Treating stridor with opioids: a challenging case of paradoxical vocal cord movement.

A 61 year-old patient with a history of anxiety disorder presented with stridor after an uneventful laparotomy with a general anesthetic. Postoperative analgesia was withheld secondary to intermittent oxygen desaturation. She was unresponsive to standard therapies, including racemic epinephrine and albuterol nebulizers.

Acute lung injury after thoracic surgery.

In this review, the authors discussed criteria for diagnosing ALI; incidence, etiology, preoperative risk factors, intraoperative management, risk-reduction strategies, treatment, and prognosis. The anesthesiologist needs to maintain an index of suspicion for ALI in the perioperative period of thoracic surgery, particularly after lung resection on the right side. Acute hypoxemia, imaging analysis for diffuse infiltrates, and detecting a noncardiogenic origin for pulmonary edema are important hallmarks of acute lung injury.

An unusual case of a patient with extreme fixed neck flexion presenting for emergency abdominal surgery.

Patients with a known difficult airway for intubation who present with intestinal obstruction are at an increased risk for receiving general anesthesia. It may be necessary to perform an awake fiberoptic intubation, or possibly a tracheostomy if an awake intubation cannot be performed. In some cases, an awake tracheostomy may not be possible due to the anatomy.