Technical communication: design and in vitro testing of a pressure-sensing syringe for endotracheal tube cuffs.

Endotracheal intubation is a frequently performed procedure in the prehospital setting, intensive care unit, and for patients undergoing surgery. The endotracheal tube cuff must be inflated to a pressure that prevents air leaks without compromising tracheal mucosal blood flow. For simultaneous endotracheal tube cuff inflation and measurement, we designed and tested a novel pressure-sensing syringe in vitro. The prototype was developed using a standard 10-mL polycarbonate syringe body that houses a plunger and a silicone rubber bellows, the pressure-sensing element. Bellow feasibility was determined and modeled using finite element analysis. Repeatability testing at each pressure measurement for each bellows (pressure versus deflection) was within an average standard deviation of 0.3 cm to 1.61 cm (1%-5% error). Using an aneroid manometer for comparison, there was excellent linear correlation with a Spearman rank of 0.99 (P < 0.001), up to 30 cm H(2)O.

Opioid-free single-incision laparoscopic (SIL) cholecystectomy using bilateral TAP blocks.

A 30 year old woman who was 8 weeks postpartum with a history of cholelithiasis and gallstone pancreatitis, and who was status-post endoscopic retrograde cholangiopancreatography (ERCP) with sphincterotomy, was treated with a single-incision laparoscopic (SIL) cholecystectomy. A transversus abdominis plane block (TAP) was performed after induction of anesthesia. The patient required no intraoperative or postoperative opioids.

Complications following large-volume epidural blood patches for postdural puncture headache. Lumbar subdural hematoma and arachnoiditis: initial cause or final effect?

Significant complications following large-volume epidural blood patches (LEBPs) in two parturients following LEBP for postdural puncture headache are reported. A 39-year-old woman developed a spinal subdural hematoma causing both lumbar back and radicular pain following a single LEBP using 58 mL of blood. The second case was a 33-year-old woman who received three LEBPs over a 4-day period totaling 165 mL of blood. She developed arachnoiditis and chronic sacral radiculopathy with resolution 4 months later.

Large intrathecal volume: a cause of true failed spinal anesthesia.

A 37-year-old woman scheduled for postpartum tubal ligation received two intrathecal doses of 2% hyperbaric mepivacaine (44 mg and 40 mg) and a subsequent single dose of 5% hyperbaric lidocaine (62.5 mg). Her sensory level never extended beyond S1. She subsequently underwent an uneventful general anesthetic, and had no residual sensory or motor deficits. An examination of the patient's lumbosacral magnetic resonance imaging (MRI) scan revealed an unusually large thecal volume. A large lumbosacral intrathecal volume may result in significant dilution or poor redistribution of hyperbaric local anesthetic. The final sensory level may be reduced or absent as a result. Intrathecal volume may be the most important non-modifiable factor affecting intrathecal distribution of local anesthetics; however, it cannot be easily measured or predicted. True failed spinal anesthesia should be distinguished from technical mishap, i.e., failing to introduce the anesthetic into the intrathecal space. The differential of a truly failed single-injection spinal anesthetic may include a large thecal volume, dural ectasias, cysts, and simple anatomic sacral restriction. To minimize maldistribution and neurotoxicity, the sum dose of all intrathecal local anesthetics administered for a single procedure should not significantly exceed the maximum recommended single-dose amount.