Clinical Anesthesia

Compiled from the author’s decades of practice in major metropolitan hospitals, this collection of cases offers an excellent review of problems – and the solutions all anesthesiologists should know. The cases are wonderfully succinct, with the problem described on one page and the solution on the next.

Residents, fellows, and practising certified registered nurse anesthetists will benefit from the retelling of these actual near misses, the solutions chosen at the time, and a retrospective analysis of those solutions that includes tips for how the problems could have been avoided altogether or resolved differently. An excellent study aid for the American Board of Anesthesiology oral exam and a useful teaching tool for faculty, since near misses such as these are relatively rare and other than reading about them, there really is no way to be prepared to successfully manage such crises. As such, even experienced anesthesiologists and CRNAs will find this to be a worthy purchase.

1          Case 1: No Fibro-Optic Intubation System – A Potential Problem

2          Case 2: Is the Patient Extubated?

3          Case 3: A Strange Computerized ECG Interpretation

4          Case 4: An Elderly Lady with a Fractured Neck of Femur

5          Case 5: A Spinal Anesthetic That Wears Off Before Surgery Ends. What to Do?

6          Case 6: Just a Simple Monitored Anesthesia Care (MAC) Case

7          Case 7: Smell of Burning in the Operating Room

8          Case 8: A Diabetic Patient for Inguinal Hernia Repair

9          Case 9: The Case of the “Hidden” IV

11        Case 11: Awake Craniotomy

12        Case 12: Gum Elastic Bougie

13        Case 13: You Smell Anesthesia Vapor. Where Is It Coming From?

14        Case 14: Manual Ventilation of a Patient Turned 180 Degrees Away From the Anesthesia             Machine by a Single Operator. Is It Possible?

15        Case 15: Life Threatening Arrhythmia in a 5 Month Old

16        Case 16: Tongue Ring

17        Case 17: Hasty C-Arm Positioning. A Recipe for Disaster.

18        Case 18: Inability to Remove a Nasogastric Tube

19        Case 19: An Unusual Cause of Difficult Tracheal Intubation

20        Case 20: Pulmonary Edema Following Abdominal Laparoscopy

21        Case 21: A Possible Solution to a Difficult Laryngeal Mask Airway Placement

22        Case 22: Postoperative Airway Complication Following Sinus Surgery

23        Case 23: An Unusual Capnograph Tracing

24        Case 24: A Respiratory Dilemma during a Transjugular Intrahepatic Porto-Systemic           Shunt Procedure (TIPSS)

25        Case 25: A Tracheotomy is Urgently Needed and You Have Never Done One

26        Case 26: General Anesthesia for a Patient with a Difficult Airway and Full Stomach

27        Case 27: A Jehovah’s Witness Patient and a Potentially Bloody Operation

28        Case 28: Laparoscopic Achalasia Surgery

29        Case 29: Sudden Intraoperative Hypotension

30        Case 30: Blood Pressure Difference between a Non-Invasive and an Invasive Blood          Pressure Measurement

31        Case 31: Severe Decrease in Lung Compliance during a Code Blue

32        Case 32: Shortening Post-Anesthesia Recovery Time after an Epidural. Is It Possible?

33        Case 33: At Times You Need To Be a MacGyver

34        Case 34: Delayed Cutaneous Fluid Leak from a Puncture Hole after Removal of an           Epidural Catheter

35        Case 35: Traumatic Hemothorax and Same Side Central Venous Access

36        Case 36: A Single Abdominal Knife Wound. Easy Case?

37        Case 37: A Draw-Over Vaporizer with a Non-Rebreathing Circuit

38        Case 38: Unexpected Intraoperative “Oozing”

40        Case 40: Check Your Facts

41        Case 41: Intraoperative Epidural Catheter Malfunction

42        Case 42: Breathing Difficulties after an ECT

43        Case 43: White “Clumps” in the Blood Sample from an Arterial Line

44        Case 44: Anesthesia for a Surgeon Who Has Previously Lost His Privileges

45        Case 45: Airway Obstruction in an Anesthetized Prone Patient

46        Case 46: A Question You Should Always Ask

47        Case 47: Postoperative Vocal Cord Paralysis

48        Case 48: This Is a Serious Problem

49        Case 49: A Leaking Endotracheal Tube in a Prone Patient

50        Case 50: An Impossible Situation?

52        Case 52: A Loud “Pop” Intra-Operatively and Now You Can’t Ventilate

53        Case 53: Postoperative Median Nerve Injury

54        Case 54: A Patient in a Halo

55        Case 55: It Is Now or Never

56        Case 56: General Anesthesia in a Patient with Daily Use of Prescribed Amphetamine

57        Case 57: What Is Wrong With This Picture?

58        Case 58: The One-Eyed Patient

59        Case 59: A Near Tragedy

60        Case 60: Robot Assisted Surgery. A Word of Caution.

61        Case 61: An Airway Emergency in an Out of Hospital Surgical Office

62        Case 62: A Case of Recent Hip Replacement Coming For a Cystoscopy

63        Case 63: A High Glucose Concentration in an Epidural Catheter Aspirate. Should             One     Be Concerned?

64        Case 64: A General Anesthesia in a Patient Who Has Had a Recent Eye Operation

65        Case 65: Another Awake Craniotomy

66        Case 66: Spinal Fracture and Flail-Segment Rib Fractures Following a Motor Vehicle        Accident

67        Case 67: Angioedema in the Emergency Department

68        Case 68: Cranioplasty. Should You Be Concerned?

69        Case 69: More Haste Less Speed

70        Case 70: A Pregnant Patient for a Carpal Tunnel Operation

71        Case 71: A Request to Provide Isoflurane Anesthesia for Treatment of Status Epilepticus

72        Case 72: No Methylene Blue in the Urine. What Would You Do?

73        Case 73: A Right Upper-Lobe Tumor and Concurrent Tracheal Polyp. What Lung             Isolation Technique Would You Use?

74        Case 74: Complete Heart Block during Central Line Placement

75        Case 75: Cervical Hematoma Following Neck Surgery

76        Case 76: Transient Language Disturbance Following General Anesthesia

77        Case 77: A Flexible Suction Catheter Complication

78        Case 78: A Neurosurgical Case with a Sudden Disappearance of the Arterial Line Waveform

79        Case 79: Not Another Corneal Abrasion

80        Case 80: A Maxillofacial Operation

81        Case 81: A Patient with a Transplanted Heart for Cholecystectomy

82        Case 82: A High Total Spinal in an Obstetric Patient

83        Case 83: Peroral Endoscopic Myotomy (POEM)

84        Case 84: A Neonatal Emergency

85        Case 85: This Could Be Serious

86        Case 86: A Case of Acoustic Neuroma

87        Case 87: Is the IV Infiltrated?

88        Case 88: Communication is Essential

89        Case 89: Watch Out

90        Case 90: A Simple Case but it Goes On and On

91        Case 91: Endotracheal Intubation in the ICU. Watch Out.

92        Case 92: A Straight Forward Case, or Is It?

93        Case 93: Postoperative Red Urine

94        Case 94: Patient’s Toes Suddenly Become White during a Lower Limb Operation

95        Case 95: A Percutaneous Tracheostomy

96        Case 96: A Patient in the Prone Position. Watch Out.

97        Case 97: A Patient with Obstructive Sleep Apnea

98        Case 98: A Case of Wegener Granulomatosis

99        Case 99: What Can Possibly Go Wrong?

100      Case 100: Severe Case of Hyperkalemia during Rapid Blood Transfusion

101      Case 101: A Monitor is Just a Machine

102      Case 102: A Case of Preoperative Sinus Tachycardia

103      Case 103: Bonus Question