Complications From Operator Modification of the Esophageal Temperature Probe.

Intraoperative temperature monitoring of surgical patients is an important aspect of perioperative care. Central core temperature monitoring is often accomplished using an 18 French esophageal device inserted through the mouth into the esophagus, while patients are undergoing general anesthesia. Placement of a modified esophageal temperature probe (i.e. with the protective plastic covering removed) into the nasopharynx of a patient may cause significant patient harm by injuring the nasal mucosa and/or turbinates. An internal survey of current practice at our academic institution reveals that 78% of anesthesia providers modify the esophageal temperature probes, leading to an 11% injury incidence. A practical solution to avoid complications is to place a pediatric size 9 French esophageal temperature probe into the nasopharynx to monitor the central core temperature.

Brachial Plexus Block for Removal of Retained Radial Artery Sheath.

In this case, we present a lesser-known application of regional anesthesia, specifically, managing a patient with vasospasm and retained radial artery (RA) vascular sheath after coronary angiography. Providing an ultrasound-guided supraclavicular block, in combination with general anesthesia, allowed the proceduralist to remove the retained sheath after several hours of failed treatment and manipulation. Severe arterial spasm was alleviated by eliciting a sympathectomy, along with analgesia of the right upper extremity, and maintaining this post-procedure. The block optimized arterial flow through the RA post-intervention and helped manage the patients' pain from manipulation.