Clinical Anesthesia

How do physicians learn to respond to unfamiliar, unusual situations? Medical textbooks are full of helpful information, but they usually do not address complex clinical scenarios. For anesthesiologists, problems are often encountered in the operating room where textbooks and medical journals are not readily available. Even when a text is handy, practical decisions often must be made immediately. Residents in training, recent graduates, and even the most senior anesthesiologists, learn by experience. Case c- ferences and grand rounds are held in almost every hospital so that all staff members can share in their colleague’s experiences. In this book, a c- panion to Near Misses in Pediatric Anesthesia, which was originally p- lished in 1999, John G. Brock-Utne pre sents a variety of interesting cases. Dr. Brock-Utne has a unique talent for describing real clinical dilemmas and their solutions in a concise, interesting, and entertaining manner. I have known the author for more than 30 years, and his enthusiasm for teaching our residents and medical students, combined with his outstanding abilities as a clinical anesthesiologist, are legendary at Stanford Medical Center. Those same qualities are evident in this book. I believe every reader, from the novice anesthesiologist to the most senior clinician, will bene? t from the “experiences” Dr. Brock-Utne brings to this book.

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-rebreathingcircuit.- 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