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Femoral and Sciatic Nerve Blocks for Total Knee Replacement in an Obese Patient with a Previous History of Failed Endotracheal Intubation −A Case Report−

Anesth Pain Med 2011; 6: 270～274 ￭Case Report￭ Femoral and sciatic nerve blocks for total knee replacement in an obese patient with a previous history of failed endotracheal intubation −A case report− Department of Anesthesiology and Pain Medicine, School of Medicine, Catholic University of Daegu, Daegu, Korea Jong Hae Kim, Woon Seok Roh, Jin Yong Jung, Seok Young Song, Jung Eun Kim, and Baek Jin Kim Peripheral nerve block has frequently been used as an alternative are situations in which spinal or epidural anesthesia cannot be to epidural analgesia for postoperative pain control in patients conducted, such as coagulation disturbances, sepsis, local undergoing total knee replacement. However, there are few reports infection, immune deficiency, severe spinal deformity, severe demonstrating that the combination of femoral and sciatic nerve blocks (FSNBs) can provide adequate analgesia and muscle decompensated hypovolemia and shock. Moreover, factors relaxation during total knee replacement. We experienced a case associated with technically difficult neuraxial blocks influence of successful FSNBs for a total knee replacement in a 66 year-old the anesthesiologist’s decision to perform the procedure [1]. In female patient who had a previous cancelled surgery due to a failed tracheal intubation followed by a difficult mask ventilation for 50 these cases, peripheral nerve block can provide a good solution minutes, 3 days before these blocks. FSNBs were performed with for operations on a lower extremity. The combination of 50 ml of 1.5% mepivacaine because she had conditions precluding femoral and sciatic nerve blocks (FSNBs) has frequently been neuraxial blocks including a long distance from the skin to the used for postoperative pain control after total knee replacement epidural space related to a high body mass index and nonpalpable lumbar spinous processes.
Progressive Mandibular Midline Deviation After Difficult Tracheal

Anaesthesia 2013 doi:10.1111/anae.12271 Case Report Progressive mandibular midline deviation after difficult tracheal intubation J. Mareque Bueno,1,2 M. Fernandez-Barriales,3 M. A. Morey-Mas4,5 and F. Hernandez-Alfaro6,7 1 Associate Professor, 6 Professor, Department of Oral and Maxillofacial Surgery, Universitat Internacional de Catalunya, Barcelona, Spain 2 Staff, 3 Visiting Resident, 7 Director, Institute of Maxillofacial Surgery, Teknon Medical Center, Barcelona, Spain 4 Staff, Department of Oral and Maxillofacial Surgery, Hospital Son Dureta, Palma de Mallorca, Illes Balears, Spain 5 Associate Professor, Especialidad Universitaria en Implantologıa Oral, Universitat des Illes Balears, Illes Balears, Spain Summary We report condylar resorption of the temporomandibular joint after difficult intubation, leading to progressive midline mandibular deviation, subsequently treated by prosthetic joint replacement. ................................................................................................................................................................. Correspondence to: M. Fernandez-Barriales Email: [email protected] Accepted: 19 March 2013 Forces applied during difficult tracheal intubations can Following induction of anaesthesia and neuromus- cause oedema, bleeding, tracheal and oesophageal per- cular blockade, laryngoscopy with a Macintosh blade foration, pneumothorax or aspiration. Resorption of (size 3) permitted revealed a poor laryngeal view the temporomandibular joint has not been associated (Cormack-Lehane
Chapter I GENERAL CORRECT CODING POLICIES for NATIONAL CORRECT CODING INITIATIVE POLICY MANUAL for MEDICARE SERVICES

CHAP1-gencorrectcodingpolicies Revision Date: 1/1/2021 Chapter I GENERAL CORRECT CODING POLICIES FOR NATIONAL CORRECT CODING INITIATIVE POLICY MANUAL FOR MEDICARE SERVICES Current Procedural Terminology (CPT) codes, descriptions and other data only are copyright 2020 American Medical Association. All rights reserved. CPT® is a registered trademark of the American Medical Association. Applicable FARS\DFARS Restrictions Apply to Government Use. Fee schedules, relative value units, conversion factors, prospective payment systems, and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for the data contained or not contained herein. Revision Date (Medicare): 1/1/2021 Table of Contents LIST OF ACRONYMS ............................................ I-2 Chapter I ................................................... I-4 General Correct Coding Policies ............................ I-4 A. Introduction ..........................................I-4 B. Coding Based on Standards of Medical/Surgical Practice I-8 C. Medical/Surgical Package .............................I-11 D. Evaluation & Management (E&M) Services ...............I-16 E. Modifiers and Modifier Indicators ....................I-18 F. Standard Preparation/Monitoring Services for Anesthesia .................................................. I-26 G. Anesthesia Service Included in the Surgical Procedure I-26 H. HCPCS/CPT
Review Article the Management of Difficult Intubation in Children

Pediatric Anesthesia 2009 19 (Suppl. 1): 77–87 doi:10.1111/j.1460-9592.2009.03014.x Review article The Management of difficult intubation in children ROBERT W.M. WALKER FRCA* AND JAMES ELLWOOD FRCA† *Department of Paediatric Anaesthesia, Royal Manchester Children’s Hospital, Pendlebury, Manchester and †Department of Paediatric Anaesthesia, Royal Manchester Children’s Hospital, North West School of Anaesthesia, Pendlebury, Manchester Summary This article looks at the current techniques and equipment recom- mended for the management of the difficult intubation scenario in pediatric practice. We discuss the general considerations including preoperative preparation, the preferred anesthetic technique and the use of both rigid laryngoscopic and fiberoptic techniques for intuba- tion. The unanticipated scenario is also discussed. Keywords: paediatric; anaesthesia; difficult airway; difficult intubation; failed intubation; fibreoptic intubation; Laryngeal mask Introduction issues which need to be discussed in detail with the parents and the child if appropriate. This should be Generally, but not always, in pediatric practice, the performed well in advance at the preoperative visit. management of the difficult intubation scenario is a Firstly, the relative benefit of any planned surgery well predicted, well planned and hopefully well must be weighed against the possible risks of the executed procedure. However, undoubtedly, there anesthetic management. If there is any doubt sur- will be occasions when difficulty with either airway rounding either the timing of the surgery or indeed management (difficulty or inability to ventilate the the need for surgery, a full discussion should take patient or maintain an airway) and ⁄ or with endo- place with carers, child, surgeon and anesthetist to tracheal intubation is unexpected.
Nasal Intubation: a Comprehensive Review

662 Review Article Nasal intubation: A comprehensive review Varun Chauhan, Gaurav Acharya Nasal intubation technique was first described in 1902 by Kuhn. The others pioneering the Access this article online nasal intubation techniques were Macewen, Rosenberg, Meltzer and Auer, and Elsberg. It Website: www.ijccm.org is the most common method used for giving anesthesia in oral surgeries as it provides a DOI: 10.4103/0972-5229.194013 good field for surgeons to operate. The anatomy behind nasal intubation is necessary to Quick Response Code: Abstract know as it gives an idea about the pathway of the endotracheal tube and complications encountered during nasotracheal intubation. Various techniques can be used to intubate the patient by nasal route and all of them have their own associated complications which are discussed in this article. Various complications may arise while doing nasotracheal intubation but a thorough knowledge of the anatomy and physics behind the procedure can help reduce such complications and manage appropriately. It is important for an anesthesiologist to be well versed with the basics of nasotracheal intubation and advances in the techniques. A thorough knowledge of the anatomy and the advent of newer devices have abolished the negative effect of blindness of the procedure. Keywords: Blind nasal intubation, complications, epistaxis, fiber optic, nasotracheal intubation Introduction (e.g., mandibular reconstructive procedures or mandibular osteotomies) and oropharyngeal surgeries. Nasal intubation technique was first
Icd-9-Cm (2010)

ICD-9-CM (2010) PROCEDURE CODE LONG DESCRIPTION SHORT DESCRIPTION 0001 Therapeutic ultrasound of vessels of head and neck Ther ult head & neck ves 0002 Therapeutic ultrasound of heart Ther ultrasound of heart 0003 Therapeutic ultrasound of peripheral vascular vessels Ther ult peripheral ves 0009 Other therapeutic ultrasound Other therapeutic ultsnd 0010 Implantation of chemotherapeutic agent Implant chemothera agent 0011 Infusion of drotrecogin alfa (activated) Infus drotrecogin alfa 0012 Administration of inhaled nitric oxide Adm inhal nitric oxide 0013 Injection or infusion of nesiritide Inject/infus nesiritide 0014 Injection or infusion of oxazolidinone class of antibiotics Injection oxazolidinone 0015 High-dose infusion interleukin-2 [IL-2] High-dose infusion IL-2 0016 Pressurized treatment of venous bypass graft [conduit] with pharmaceutical substance Pressurized treat graft 0017 Infusion of vasopressor agent Infusion of vasopressor 0018 Infusion of immunosuppressive antibody therapy Infus immunosup antibody 0019 Disruption of blood brain barrier via infusion [BBBD] BBBD via infusion 0021 Intravascular imaging of extracranial cerebral vessels IVUS extracran cereb ves 0022 Intravascular imaging of intrathoracic vessels IVUS intrathoracic ves 0023 Intravascular imaging of peripheral vessels IVUS peripheral vessels 0024 Intravascular imaging of coronary vessels IVUS coronary vessels 0025 Intravascular imaging of renal vessels IVUS renal vessels 0028 Intravascular imaging, other specified vessel(s) Intravascul imaging NEC 0029 Intravascular
THE BONFILS INTUBATION ENDOSCOPE in Clinical and Emergency Medicine

® THE BONFILS INTUBATION ENDOSCOPE in Clinical and Emergency Medicine Tim PIEPHO Rüdiger NOPPENS ® THE BONFILS INTUBATION ENDOSCOPE in Clinical and Emergency Medicine Tim PIEPHO Rüdiger NOPPENS Department of Anesthesiology University Medical Center of the Johannes Gutenberg University Mainz, Germany With contributions from: Andreas THIERBACH Rita METZ Pedro BARGON 4 The BONFILS Intubation Endoscope in Clinical and Emergency Medicine Important notes: The BONFILS Intubation Endoscope Medical knowledge is ever changing. As new research in Clinical and Emergency Medicine and clinical experience broaden our knowledge, Tim Piepho and Rüdiger Noppens changes in treat ment and therapy may be required. Department of Anesthesiology, The authors and editors of the material herein have University Medical Center of the Johannes Gutenberg University Mainz, Germany consulted sources believed to be reliable in their efforts to provide information that is complete and in accord with the standards accept ed at the time of publication. However, in view of the possibili ty of human error by Correspondence address: the authors, editors, or publisher, or changes in medical Tim Piepho knowledge, neither the authors, editors, publisher, nor Klinik für Anästhesiologie any other party who has been involved in the preparation Universitätsmedizin der Johannes Gutenberg-Universität Mainz of this booklet, warrants that the information contained Langenbeckstr. 1 herein is in every respect accurate or complete, and they Telephone: +49 (0)6131/171 are not responsible for any errors or omissions or for the results obtained from use of such information. The E-mail: [email protected] information contained within this booklet is intended for use by doctors and other health care professionals.
Xellia Pharmaceuticals, Aps Advisory Committee Background Document

BACITRACIN for Injection (bacitracin) Advisory Committee Background Document Staphylococcal pneumonia and empyema in infants Xellia Pharmaceuticals, ApS Advisory Committee Background Document Meeting of the Antimicrobial Drugs Advisory Committee (AMDAC) on Safety and Efficacy of Bacitracin for Intramuscular Injection BACITRACIN for Injection (bacitracin) AVAILABLE FOR PUBLIC DISCLOSURE WITHOUT REDACTION Issue/Report Date: 28 March 2019 Approved date: 27 March 2019 Page 1 of 52 BACITRACIN for Injection (bacitracin) Advisory Committee Background Document Staphylococcal pneumonia and empyema in infants Table of Contents 1 EXECUTIVE SUMMARY ............................................................................................................5 2 Introduction .....................................................................................................................................7 3 Clinical data on effectiveness of bacitracin for injection ................................................................8 3.1 Approved Indication: Staphylococcal Pneumonia and Empyema in Infants ........................... 8 3.1.1 Supporting data on the treatment of lung infections in adults ........................................... 9 3.1.2 Data on intrapleural administration in infants and children with empyema ...................... 9 3.2 Alternate uses for Bacitracin for injection .............................................................................. 10 3.2.1 Surgical Site Infection (SSI) Prophylaxis .......................................................................
Esophagogastric Tamponade Tube Practice Guideline

Practice Guideline: Esophagogastric Tamponade Tube (EGTT): Assisting with Insertion, Care and Removal CLINICAL Approval Date: Pages: PRACTICE April 28, 2017 1 of 9 GUIDELINE Approved By: Supercedes: Standards Committee N/A Professional Advisory Committee 1. PURPOSE AND INTENT 1.1 To provide guidance and support for the safe insertion, care and maintenance and removal of an Esophagogastric Tamponade Tube (EGTT). Registered Nurses in WRHA Critical Care Units, WRHA Cardiac Sciences, and Emergency Departments may assist with insertion; and provide ongoing care for patients requiring EGTT placement. This guideline is also intended to provide guidance and support to assit the Physician with the insertion of the EGTT. 2. PRACTICE OUTCOME 2.1 Cessation of variceal bleeding and resolution of hypovolemic shock. 3. BACKGROUND 3.1 Esophageal and gastric varices develop because of portal hypertension and vascular congestion. Rupture of the dilated veins may result in gastrointestinal hemorrhage and hypovolemic shock. Without immediate bleeding control, death occurs. Tamponade therapy exerts direct pressure against the varices with a gastric or esophageal balloon and may be used for patients unresponsive to medical therapy (including endoscopic hemostasis and vasoconstrictor therapy) and those too hemodynamically unstable to undergo endoscopy or sclerotherapy. 3.2 Esophagogastric tamponade tubes are used to control bleeding from gastric or esophageal varices. The suction lumens allow the evacuation of accumulated blood from the stomach or esophagus and intermittent instillation of saline to help evacuate blood or clots. Practice Guideline: Esophagogastric Tamponade Tube (EGTT): Assisting with Insertion, Care and Removal CLINICAL Approval Date: Pages: PRACTICE April 28, 2017 2 of 9 GUIDELINE Approved By: Supercedes: Standards Committee N/A Professional Advisory Committee 4.
Pneumopericardium and Pneumomediastinum Complicating Endotracheal Intubation D

Postgraduate Medical Journal (April 1979) 55, 273-275 Postgrad Med J: first published as 10.1136/pgmj.55.642.273 on 1 April 1979. Downloaded from Pneumopericardium and pneumomediastinum complicating endotracheal intubation D. O'NEILL D. N. K. SYMON M.B., Ch.B., M.R.C.P. B.Sc., M.B., Ch.B., M.R.C.P. Department of Cardiology, Western Infirmary, Glasgow GIl 6NT Summary was promptly inserted by the house physician. This Pneumopericardium and pneumomediastinum have type of tube has a total length of 30 cm with mark- been described as complications of endotracheal ings at 22, 24 and 26 cm. It was not trimmed before intubation and assisted ventilation in neonates and insertion. Copious secretions were aspirated and children. Here the occurrence of these complications intermittent positive pressure ventilation commenced in an adult is described and the possible mechanism using an Ambu bag. It was then noticed that the discussed. left lung was not being inflated and the tube was partially withdrawn. Ventilation with the Ambu bag Introduction was continued for 30 minutes until spontaneous The use of the endotracheal tube during surgery ventilation returned. During this period gastric has become the most widely used and acceptable lavage was carried out after an oro-gastric tube had method of providing an airway and of assisting in been passed without difficulty. Protected by copyright. the ventilation of the patient. Although some On admission to the intensive care unit he was complications do arise, the beneficial aspects of the noted to have a loud pericardial friction rub audible procedure have far outweighed the limitations due to over the entire praecordium.
Elective Intubation

Elective Intubation Charles G Durbin Jr MD FAARC, Christopher T Bell MD, and Ashley M Shilling MD Introduction Intubation: Perioperative Versus Outside the Operating Room Patient Examination and Airway Evaluation Predictors of a Difficult Airway Mouth Opening and Dentition Oral Cavity and Neck Mobility Evaluation Physiologic Risks of Intubation Environmental Assessment and Preparation Managing Airway Risks Outside the Operating Room Monitoring Intubation: Plans A, B, and C Preparing for Intubation Physical Considerations and Time-Out Denitrogenation or Preoxygenation Intubation Using Direct Laryngoscopy Initial Plan Confirmation of Tracheal Intubation Physiologic Changes and Management Strategies Alternative Airway Plans Postintubation Plans Transfer of Care After the Difficult Intubation: A Case Review Conclusions Endotracheal intubation is a commonly performed operating room (OR) procedure that provides safe delivery of anesthetic gases and airway protection during surgery. The most common intuba- tion technique in the perioperative environment is direct laryngoscopy with orotracheal tube in- sertion. Infrequently, difficulties that require an alternative intubation technique are encountered due to patient anatomy, equipment limitations, or patient pathophysiology. Careful patient evalu- ation, advanced planning, equipment preparation, system redundancy, use of checklists, familiarity with airway algorithms, and availability of additional help when needed during OR intubations have resulted in exceptional success and safety. Airway difficulties during intubation outside the controlled environment of the OR are more frequent and more serious. Translating the intubation processes practiced in the OR to intubations outside the perioperative setting should improve patient safety. This paper considers each step in the OR intubation process in detail and proposes ways of incorporating perioperative procedures into intubations outside the OR.
IAO International Archives of Otorhinolaryngology

International Archives of IAO Otorhinolaryngology ProfOrganizing. Ricardo Committee F erreira Bento Virtual Congress of theHe Otorhinolaryngologyaring & Balanc Foundatione 2017 PreProf.sident Dr. Richard Louis Voegels DrProf.. RDr.obinson Ricardo Ferreira Koji Bento Tsu ji President of Scientiﬁc Comission Dra. Ana Carolina Fonseca General Secretary 2020 OFFICIAL PROGRAM ABSTRACTS CCALLALL FFOROR PPAPERSAPERS YYouou areare invitedinvited to to submit submi tthe th efull ful articlesl article presenteds presente atd at VirVirtualth Congress Congress of Otorhinolaryngology of Otorhinolaryngology Foundation Foundation free free of of cost to thethe InternationalInternational ArchiArchivesves ofof OtorhinolaryngologyOtorhinolaryngology.. IAO is an international peer-reviewed journal focusing on disorders of the ear, nose, mouth, pharynx, larynx, cervical region, upper airway system, audiology and communication disorders. Published quarterly, the journal covers the entire spectrum of otorhinolaryngology – from prevention, to diagnosis, treatment and rehabilitation. ISSN 1809–9777 International Archives of IAO Otorhinolaryngology Editor in Chief Issue 3 • Volume 24 • July – August – September 2020 Why publish in IAO? Geraldo Pereira Jotz Co-Editor Aline Gomes Bittencourt • Rigorous Peer-Review by Leading Specialists. • International Editorial Board. • Continuous Publication: Speeding up the Publication of Articles. • Web-based Manuscript Submission. • Complete Free Online Access to all Published Articles via Thieme E-Journals at www.thieme-connect.com/products