Severing of the pilot balloon of an endotracheal tube (ETT) results in cuff deflation and may lead to complications including inadequate patient ventilation, increased risk of aspiration and infection, and operating room air pollution with anesthetic gases. In situations where ETT exchange or reintubation may pose a significant risk to the patient, temporary repair of the severed cuff tubing can be helpful until it is safe to address the problem with replacing the ETT. Simple and effective repair methods can be achieved using readily available materials in the operating room, including intravenous cannulas, hypodermic syringes, and epidural clamp connectors. However, choosing which technique or method depends mainly on personal preference, equipment availability, and provider comfort and experience. We present a 12-year-old adolescent who presented for anesthetic care for extensive burn injury. During removal of the dressing around the head and face, the tubing of the pilot balloon of the ETT was inadvertently cut. Options for dealing with such problems are discussed, including techniques to allow for temporary repair and re-inflation of the deflated cuff.
Carnitine-acylcarnitine translocase (CACT) deficiency is a rare disorder of mitochondrial fatty acid metabolism that results in an acute encephalopathic and/or myopathic disorder. Carnitine and CACT play an essential role in the transport of fatty acids into the mitochondria. The deficiency leads to the reduced transport of long-chain fatty acids into the mitochondria, thereby limiting the use of fatty acids for energy production especially during prolonged fasting, febrile illnesses, increased muscular activity, and other periods of systemic stress. We present the anesthetic management of a 10-year-old girl, diagnosed with CACT deficiency at birth, who presented for multiple osteotomies. The preoperative evaluation of such patients is presented, previous reports of anesthetic care are reviewed, and options for intraoperative care are discussed.
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