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was maintained with nitrous oxide and oxygen, isoflurane, and vecuronium, as well as a supplemental infusion of remifentanil. The procedure was progressing smoothly until the third hour of this scheduled 8-hour case. The overhead lights suddenly flickered, and all the individuals in the operating room sensed a noticeable surge of power. The ventilator, anesthesia monitors, compurecord, and surgical equipment all continued to function normally, and for the next 20 minutes the surgery continued without interruption. However, the air conditioning seemed to have

assistant were positioned at 9 and 3 o'clock, respectively, relative to the dental mannequin head. Simulated Cough For the simulated coughing portion of the study, a third individual (anesthesiologist), wearing a face shield in addition to the same personal protective equipment (PPE) as the dentist and the dental assistant, was positioned at 12 o'clock relative to the dental mannequin head. This person took the role of managing the simulated patient's airway. To simulate coughing, a ventilator was fabricated using the

/60 mm Hg and pulse = 81/min. Initial ventilator settings were tidal volume = 500 mL, rate = 10/min with positive end-expiratory pressure of 5 cm H 2 O, and a fraction of inspired oxygen of 1.0. A Foley catheter was inserted for urine output monitoring. A lubricated 18 Fr NGT was inserted through the left nostril without difficulty and was secured at 55 cm at the nostril. Clear secretions were suctioned and the proximal end of the NGT was closed and left undisturbed. Fifteen minutes after induction patient became hypotensive with a blood pressure of 62/46 mm Hg

subject's electronic medical record, the subject's physical perioperative chart, and interview of the subject's parent(s) and/or guardian(s) prior to anesthesia and were recorded on the data collection instrument. Mallampati scores were obtained during the preoperative physical examination and recorded on the data collection instrument. Cormak-Lehane scores seen during intubation, method of laryngoscopy (direct or video), a description of intubation (eg, atraumatic, easy, difficult), ETT size used, V T set on the ventilator, and whether or not there was a significant

dramatically increased and the delivered anesthetic gas concentrations decreased. In the present patient, the delivery of aerosolized medications through a small-diameter nasal RAE ETT presented challenges that are quite different from those encountered in adult-sized patients. The acute bend in the nasal RAE ETT prevents the aerosols from effectively reaching the lungs. The lower lung volumes, long length of the ETT relative to patient size, the small inner diameter of the ETT, and the mechanical ventilator settings used in pediatric patients decrease the total drug

intermittent or continuous drainage of the subglottic space ( Figure 1 ). These specially designed ETTs have been shown to be effective for managing intubation-related secretions and reducing the incidence of ventilator-associated pneumonia for critically ill patients in the intensive care unit. 7 – 10 Moreover, the ETT suction lumen also can be used to facilitate irrigation of the subglottic space, permitting delivery of a relatively large volume of irrigation fluid that can be easily and completely evacuated from the oropharyngeal space under visualization with a video

; infusion pumps; and ventilators. These alarm-equipped devices are essential to providing safe care to patients in many health care settings; clinicians depend on these devices for information they need to deliver appropriate care and to guide treatment decisions. However, these devices present a multitude of challenges and opportunities for health care organizations when their alarms create similar sounds, when their default settings are not changed, and when there is a failure to respond to their alarm signals. The number of alarm signals per patient per day can reach

inspiratory-to-expiratory time (I:E) ratio of the ventilator was set at 1:3. Two grams of cefazolin sodium was administered before the surgical incision was made. Soon after the surgeon began the procedure, the patient's abdomen was insufflated with carbon dioxide and the patient was placed in reversed Trendelenburg position. His blood pressure was maintained with a phenylephrine infusion at 0.3–0.6 mcg/kg/min along with a crystalloid infusion. Approximately 40 minutes after induction, peak pressures increased significantly from a low of 24 cm H 2 O to a high of 39

order of what follows. Is this an adult or a child? Does the patient have cardiac issues? Pulmonary problems? Diabetes mellitus? If this problem develops intraoperatively, what has been the patient's course over time as I have closely monitored them for the previous minutes or hours? Although their pressure or ventilation parameters were all within a reasonable range that might be unnoticed if taken as a spot check, have they been subtly changing? Have I had to make adjustments to ventilation via medications if spontaneously breathing or via the ventilator? Have I

(Flexible Corrugated Tube Holder Set Type F, ACOMA Medical Industry Co, Ltd; Figure 1 A). At that time, the anesthesiologist felt resistance, but because she was anxious to start the surgical operation, she continued to push the corrugated tubing into place. Shortly thereafter, a leaking sound was heard emanating from the corrugated tubing and the ventilator alarm sounded to signal a decrease in tidal volume. The anesthesia breathing bag would not inflate and ventilation could not be performed even when the adjustable pressure-limiting valve was completely closed. The