A single consent for serial anesthetics in burn surgery.

Obtaining anesthesia informed consent for a series of repetitive debridements in burn-injured patients requires a significant time investment for anesthesiologists and patient families. A single consent form was introduced that covered multiple related anesthetics in burn patients. The number of consents per patient before and after implementation was analyzed using Welch ANOVA; Tukey-Kramer post hoc test, with 99% confidence intervals for mean differences was used to examine pairwise comparisons. The mean number of consents per patient was 4.5 ± 2.8 and 1.6 ± 0.51 (P < 0.001) before (2010) and after implementation (2013), respectively. The Multiple Related Anesthetics Consent Form in this population resulted in less time spent by anesthesia providers in obtaining consent for patients undergoing multiple related procedures while providing patient- and family-centric care.

Airway management of patient with Smith-Lemli-Opitz syndrome for gastric surgery: case report.

A case of term, 5-day-old boy, with low birth weight of 2.4 kg, with Smith-Lemli-Opitz syndrome (SLOS) who was first scheduled for gastrostomy tube placement and later for pylorotomy, is discussed. General appearance of face and small chin showed possible difficulties during intubation, which are well known from the literature. Anesthetic plan included possibility of fiberoptic intubation. Mask induction and ventilation had been successful but attempts to intubate patient using fiberoptic bronchoscope had not been feasible and both procedures had been performed using laryngeal mask airway (LMA#1) with spontaneous ventilation without complications. In this case, we are showing the ability to secure the airway in a small infant with SLOS using LMA and the possibility to perform successfully surgery on the gastrointestinal tract.

Reducing the incidence of surgical fires: supplying nasal cannulae with sub-100% O2 gas mixtures from anesthesia machines.

In June 2003, the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) recommended: "As a general policy, use air or FiO2 at < or =30% for open delivery (consistent with patient needs)" to prevent surgical fires. One way to interpret JCAHO's recommendation is that 100% O2 should not be indiscriminately used, and anesthesia providers should have the ability, consistent with patient needs and their clinical judgment, to deliver sub-100% O2 with nasal cannulae. An auxiliary O2 flowmeter has a barbed outlet connector that offers a convenient means to connect a cannula to an anesthesia machine and is routinely used for open delivery of 100% O2. The auxiliary O2 flowmeter provides only 100% O2 and thus does not allow titration of the O2 concentration to patient needs and may increase the risk of surgical fires. This report clarifies the JCAHO recommendation and describes different means of addressing it that are based primarily on using the anesthesia machine to blend a sub-100% O2 gas mixture and delivering it via a nasal cannula. The options presented depend on the model and manufacturer of the anesthesia machine and allow delivery via nasal cannula of O2 concentrations that range from 21% to 100%.