Our department has a large number of McGrath video laryngoscopes. The battery packs were stored in the anesthesia tech room as follows:
This seemed like a poor way to store batteries that cost $75 each. I Designed and 3D printed a tray to hold the batteries; the goal being to provide better organization, improved accessibility, and assist the techs with inventory/ordering. Here is the 3D design:
And here is the final printed product:
We provided a general anesthetic to a 35 year old male for surgical reduction of a displaced clavicular fracture. The patient’s history was significant for obesity and daily tobacco smoking. During preoperative assessment the patient was noted to have a hoarse voice; however, we were reassured by the patient’s report that his voice had been this way for “a very long time.” A previous anesthetic record was avalible and notable for two hand mask ventilation with an oral airway and grade 2B intubation view with direct laryngoscopy. His BMI had increased from 27 to 39 since the previous record.
We performed a standard induction which was initially notable for very difficult mask ventilation. We performed planned video laryngoscopy with a McGrath MAC #4 resulting in the following view:
Due to difficult mask ventilation we proceeded with intubation without fully investigating the mass. The mass was mobile posteriorly and we were able to easily pass a 6.0 ETT into the trachea:
Since the patient’s injury required urgent repair, we proceeded with the surgery without delay. We called for an intraoperative ENT consult. The ENT surgeon used a gum bougie to delineate the mass and determined that it was attached anteriorly and such masses are unlikely to compromise an airway acutely. Since extubation was likely safe, the ENT surgeon did not perform a biopsy or excision, so the patient could be properly consented for the procedure at a later date. We extubated the patient fully awake without complication.
In the PACU we questioned the patient again with family present. The patient’s wife immediately reported that she noticed a worsening of the patient’s usual hoarseness over the past 3 months.
The patient returned to the OR 1 week later for definitive diagnosis and excision of the mass. We induced the patient and intubated with a Karl Storz C-MAC S MAC #4 and 5.0 microlaryngoscopy ETT:
The mass was resected by the ENT surgeon and was shown to be a papilloma by pathology.
What better addition to your office knick knacks than a Lego Minifig anesthesiologist. Unfortunately, the only available minifigs are generic doctors; no accessories are available to indicate our noble profession. I started with the Lego “surgeon” minifig and planned to create my own Lego sized laryngoscope. I found a 3D model on Thingiverse by user Mvetto labelled laryngoscope pendant to start with. I edited the proportions to fit a minifig hand and exaggerated the size of the blade to make it the model somewhat comical. Here is the result, a custom anesthesiologist minifig.
You can find the minifig on Amazon: Link
If you’re interested in anesthesia and operating room lego builds, the flickr account of canadian anesthesiologist Lucie Filteau has some really cool setups: Here
The following was encountered while intubating a 50 year old male with a history of neck radiation for the treatment of esophageal cancer and resection of his epiglottis and tongue base. The patient was 20 hours NPO and denied any history suggestive of active esophageal pathology.
[[[[[NEED TO ADD VIDEO]]]]]
We optimized airway positioning with external laryngeal manipulation and placed an endotracheal tube over a gum bougie and continued to the patient’s unrelated orthopedic fixation.
We induced a healthy 45 year old female for cholecystectomy for a history a biliary colic. The patient had an unremarkable airway exam and denied any abnormal ENT symptomatology. After induction the junior resident mentioned “confusing” anatomy on direct laryngoscopy; we performed video laryngoscopy to investigate producing the following images:
 |  |
We obtained an intraoperative ENT consult and they suspected that it was a lipoma. Since the lesion would not compromise the airway, the ENT team elected to perform a biopsy at a later date so that the patient could be properly consented for the procedure.
The patient was seen in ENT clinic the following week and a surgical excision was performed the following month uneventfully. Pathologic examination confirmed it to be a lipoma as expected.
The oridion and nellcor portable capnometers are valuable tools offered by Medtronic for continuous etCO2 monitoring outside the OR. I frequently bring the handheld device with me to floor intubations and codes allowing for rapid troubleshooting of ETT placement and monitoring of effective chest compressions.
At the time of this writing there appears to be an abundance of AS-IS devices available on eBay for minimal cost; the majority of the devices do not come with the power cable. I was betting that these items were sold AS-IS because the device uses an unusual RJ-45 (Ethernet) based charging cable and the sellers did not want to invest $200+ on a new cable from Medtronic to test the devices.
I purchased a lot of 3 Oridion Microcaps sold “AS-IS for parts only” from eBay for $75.00.
Since we have a couple of the Nellcor devices at our institution I was able to use the OEM power brick as a reference. The brick has all the necessary info to produce a similar device:
I purchased the following power supply from amazon and wired up a rough adapter following the wiring diagram on the OEM power supply:
The result? All three Microcaps are fully functional. The last component was to produce a more finished product:
Items used for this project:
– Universal DC adapter.
– Female 2.1mm x 5.5mm connector Amazon item listed as an example, however, I purchased mine off eBay for $1 (if you don’t mind waiting 1-2 months).
– Ethernet Cable You likely have one of these sitting around, unused.
– Electrical Tape or wire heat shrink for a nicer appearing repair.
– Wire stripper.
