Clinical Anesthesia: Near Misses and Lessons Learned

Description

Those familiar with the 1^st edition of this book from 2008 will recognize the original 62 cases that have been modernized with updated references and enjoy the addition of 41 brand new cases. Clinical Anesthesia: Near Misses and Lessons Learned, 2nd edition is a collection of actual cases, complied from the author’s forty years of practice in major metropolitan hospitals in the United States, Norway and South Africa. It offers the reader succinct case presentations describing a problem on one page and a solution on the next, with a discussion, other potential solutions with satisfactory outcomes, and tips to help avoid problems altogether when possible. Clinical Anesthesia: Near Misses and Lessons Learned, 2nd edition serves as an easy and practical way for the reader to gain familiarity with potentially unexpected problems in clinical anesthesia

In addition, this can be an excellent study aid for the American Board of Anesthesiology oral exam. Since near misses are relatively rare, there really is no way to be prepared to successfully manage such crises other than reading about them, so residents, fellows, and practicing, certified registered nurse anesthetists will benefit from the learning of these actual near misses. Additionally, faculty will find the plethora of discussion topics for large or small group settings an ideal way to communicate anesthesia and clinical care problems to the audience.

Key Features

• Review of potential problems and solutions all anesthesiologists should be familiar with
• Updated edition offers new cases on using general anesthesia on a patient who has had a recent eye operation,  a case of a spinal fracture, extubating a patient in the ICU, and an introperative cold ischemic hand
• Offers succinct case presentations that describe a problem and the solution, with each write-up concluded by a retrospective analysis examining whether the solution used was actually the best (or only) choice
• Serves as an easy and practical way for the reader to gain familiarity with unexpected problems in clinical anesthesia
• Residents, fellows, and practicing, 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 include tips for how the problems could have been avoided altogether or resolved differently
• Used as an excellent study aid for the American Board of Anesthesiology oral exam and a useful teaching tool for faculty

Table of Contents

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
10. Case 10: Postoperative Painful Eye
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”
39. Case 39: Central Venous Access and the Obese Patient
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?
51. Case 51: An “Old Trick” But a Potential Serious Problem
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. 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

Author Biography

John G. Brock-Utne is currently a professor of Anesthesia and the Associate Director of the Anesthesia Residency Program at Stanford University Medical School. He has written over 200 peer reviewed articles and 370 abstracts and letters, including the book Near Misses in Pediatric Anesthesia.