Western Anesthesia Residents Conference

372 Pages·2017·2 MB·English

by  Mandi Mizuta

55th Annual
Western Anesthesia
Residents Conference
April 21-23, 2017
The Sentinel Hotel
Portland, OR
Hosted by Oregon Health & Science University
WARC 2017 Conference Schedule
Day Time Agenda topic
Friday, April 21, 2017 12:00 - 7:00pm Conference check-in & registration
12:00 - 3:30pm @ The Sentinel Hotel
4:00 - 7:00pm @ the Columbia store, downtown
Portland
1:00 - 4:30 pm Chief Leadership Conference
4:00-7:00 pm Social mingling/shopping event/Conference check-in
at the Columbia store, downtown Portland
4:30 - 6:30 pm Chief Resident Activity (private Brewvana tour)
7:00 - 8:30 pm Chair Dinner, The Sentinel Hotel
7:00 - 8:30 pm Chief Resident Dinner, The Sentinel Hotel
Saturday, April 22, 6:30 am - 12:00 pm Registration
2017 6:30 - 7:30 am Breakfast
7:30 - 9:30 am Oral presentations/Exhibitors
9:30 - 10:00 am Coffee Break/Exhibitors
10:00 am - 12:00 pm Oral presentations/Exhibitors
12:00 - 1:30 pm Lunch and keynote speakers
2:00 - 4:30 pm Oral presentations/Exhibitors
4:30 - 7:00 pm Poster reception, happy hour, and judging
4:30-5:30 Poster Session 1
6:00-7:00 Poster Session 2
7:00 pm - on Dinner around town
Sunday, April 23, 8:00 - 9:00 am Breakfast & Awards
2017 9:00 - 9:15 am Intro to mock Deposition
9:15 - 9:45 am Coffee Break/Exhibitors
9:45 am - 12:00 pm Mock Deposition
Make your own sandwich buffet (to-go containers will
12:00 pm
be available)
Optional exclusive shopping opportunity at the Nike
After 12:00 pm
Employee Store (everything in the store is 50% off).
The 55th Annual Western Anesthesia Residents’
Conference is grateful for the support of the
following sponsors:
GOLD
Silver Level
Silver Level
Bronze Level
Premium Level

Supporter
A case of general anesthesia for the patient with a large
epiphrenic esophageal diverticulum complicated by severe
tracheal stenosis
Background: The joint presentation of elevated aspiration risk and difficult airway is
uncommon. Epiphrenic esophageal diverticulum (EED) is a rare disease with an estimated
incidence of 1:500,000 cases annually. It is associated with an increased risk of aspiration for
patients who undergo general anesthesia, which necessitates prompt securement of the airway
upon induction. However, coexisting tracheal stenosis challenges the airway management for
these particular patients. There are no published case reports describing these problems as
independent issues in a single case. We describe the anesthetic management for a laparoscopic
fundoplication in a patient with a large EED and severe tracheal stenosis. Case Description: A
66-year-old woman with EED presented for a laparoscopic esophageal diverticulectomy, Heller
myotomy, and Toupet fundoplication for dyspnea and worsening regurgitation. Previous
esophagogram showed a 5.9 x 4.6 x 6.7-cm lower esophageal diverticulum (see Figure). During
a workup for her dyspnea, the patient was found to have tracheal stenosis with a diameter of 4
mm at its narrowest; consequently, her trachea was dilated to 14 mm in 2014. Her anesthesia
record at the time noted an uneventful course including easy mask ventilation following
induction. Since the dilatation, there were no changes in symptoms or follow-up procedures to
suggest relapse of tracheal stenosis. On the morning of surgery we discussed with the surgical
team and assembled appropriate airway equipment and backup devices to accommodate
possible conversion to thoracic approach. The patient was pre-oxygenated and placed in the
Semi-Fowler’s position. Anesthesia was induced with propofol and succinylcholine following
the RSI protocol. We began our intubation attempts with a 35-French (Fr) MallinckrodtTM
double-lumen endotracheal tube (DLT; outside diameter [OD] 13.3 mm) and subsequently a 33-
Fr DLT (OD 12.3) using a GlideScope, but unexpectedly failed. Then we switched to
MallinckrodtTM single-lumen endotracheal tubes (ETT) via fiberoptic intubation. We were
unable to pass a 7.0 ETT (OD 9.5) or a 6.5 ETT (OD 8.9), but managed to guide a 6.0 ETT (OD
8.2) through the most constricted portion of the patient’s trachea. Following intubation,
auscultation of the lungs revealed clear breath sounds bilaterally. The fundoplication was
performed successfully by abdominal approach without need for lung isolation. The ENT team
was then consulted intraoperatively to perform tracheal dilation; they replaced the existing 6.0
ETT with an 8.0 ETT (OD 11.0 mm) without resistance. Upon emergence, the patient was fully
awake and a negative cuff-leak test was achieved. We subsequently inserted a CookTM airway
exchange catheter through the 8.0 ETT tube and extubated her while leaving the catheter in
place. The patient maintained a patent airway and the catheter was removed thereafter. The
patient’s postoperative course was uneventful; she was discharged home on her third
postoperative day. Discussion: We demonstrated the successful anesthetic management of a
patient with a high potential for pulmonary aspiration and difficult airway. In this case it was
critical to communicate well with the surgical teams, perform a careful assessment of airway
and imaging studies, conduct full aspiration precautions, and avoid inadvertent insertion of
equipment into an abnormal esophagus.
Poster Presentation
Presenting Author: Dr. Brian Truong University of Washington
Authors:
Dr. Brian Truong University of Washington
Dr. Kyota Fukazawa University of Washington