Uncommon Occurrence of an Air Embolism during the Preanhepatic Phase of an Orthotopic Liver Transplant.

Vascular air embolism (VAE) during liver transplantation usually occurs during the dissection phase of the procedure or during liver reperfusion. If this phenomenon occurs, it can cause significant cardiovascular, pulmonary, and neurological complications. Prompt identification of VAE is essential, and the surgeon should be immediately notified. The mainstay treatment is identification and rectification of the source of the air embolus, hemodynamic support, and prevention of further air entrainment. This case report describes the occurrence of a pulmonary air embolism during the preanhepatic phase of an orthotopic liver transplant.

Anesthetic management during bronchoscopy of patients with pulmonary hypertension.

This article is intended to provide an overview of the anesthetic management for bronchoscopic procedures in patients with pulmonary hypertension (PH). This includes the classifications of PH, diagnosis with severity, and treatment modalities as detailed knowledge of this condition is imperative for proper anesthetic management. Preoperative evaluation and optimization of the patient is discussed as well. Bronchoscopic procedures require airway manipulation and compromise ventilation for lengths of time. As hypoxemia and hypercarbia trigger decompensation in PH, this may lead to a downward spiral if control is lost. Therefore a discussion of the intraoperative anesthetic management and the critical concerns are detailed in this article, as well as treatment modalities and management for said concerns.

A Case Report of an Inadvertent Placement of Tracheostomy Tube Into the Pharynx After Emergency Tracheostomy: Management of a Failed Surgical Airway.

Inadvertent placement of a tracheostomy tube through the stoma with the distal tip cephalad in the pharynx is an unusual but potentially devastating complication. Previously reported only once in the literature, its occurrence is not well known. There are several causes of ineffective ventilation after an emergency surgical airway, and an incorrectly placed tracheostomy tube is a differential diagnosis to consider. Prompt identification of this rare complication is essential because the consequences can be fatal. We present a case describing the inadvertent insertion of a tracheostomy tube into the pharynx during emergency tracheostomy and its subsequent management.

Diagnostic and therapeutic challenges in managing persistent air leaks.

Persistent air leak (PAL) is a common and challenging condition associated with increased morbidity and mortality, intensive care unit admission, and prolonged hospital stay. Multiple medical and surgical approaches have been developed to manage PAL. Depending on the etiology of PAL, surgical management may be effective and usually performed using video-assisted thoracoscopic surgery (VATS). Medical management is less invasive and consists of pleural or bronchoscopic methods. The non-surgical techniques for the management of PAL have not been investigated in large prospective studies, and so their use is mostly guided by observational data. Specifically, the role of intrabronchial valve (IBV) placement for PAL has been the subject of an ever-increasing number of case reports and series documenting successful deployment of IBVs for both surgical and medical PAL. In this case-based discussion, we describe three patients with non-surgical PAL who were managed using multiple modalities, including both surgical and medical approaches. These cases illustrate the challenges in identifying the location of the air leak and in the application of various therapeutic options.

Quadruple Vessel Coronary Artery Bypass Grafting in a 14-Year-Old Child With Plasminogen Activator Inhibitor-1 4G/4G Gene Polymorphism.

Myocardial ischemia due to coronary artery disease is an extremely rare condition in childhood and adolescence. Absence of obvious serious risk factors remains a challenge to modern cardiology. We present the case of a 14-year-old boy who underwent quadruple-vessel coronary artery bypass grafting with bilateral pedicled internal mammary artery and bilateral radial artery grafting. We try to highlight a rare but important 4G variant PAI-1 (SERPINE 1) gene mutation as the etiology of severe coronary artery disease in our patient. To the best of our knowledge, he is one of the youngest patients who underwent coronary artery bypass surgery with 4 arterial grafts.