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This chapter presents a case study of a 76-year-old female arrived in the postanesthesia care unit (PACU) after an uneventful left carotid endarterectomy (CEA) for a severe left internal carotid artery stenosis. On emergence from anesthesia, she developed severe hypertension requiring intravenous nitroglycerin boluses as well as intravenous labetalol. Airway management is often challenging in the PACU or critical care unit. Postoperative bleeding after CEA is particularly hazardous because bleeding into a closed space can quickly result in an expanding neck hematoma that can cause impingement on laryngeal structures and airway compromise. In cases of progressive expansion of the neck hematoma, even in the absence of airway compromise, awake intubation may be prudent, followed by surgical exploration of the wound and drainage of the hematoma. If ventilation is unsuccessful or becomes inadequate despite drainage of the neck hematoma, invasive airway access should proceed.
Neurosurgical procedures are very rarely performed in a straightforward supine position. This chapter presents a case study of a 69-year-old female with a history of renal cell carcinoma developed new back pain and radiculopathy. Resuscitation efforts continued while the wound was packed and the patient was repositioned supine to facilitate external cardiac compressions. The wound continued to bleed during the unsuccessful resuscitation effort. This case was an exposure to the surgical site of bleeding was poorly accessible due to the need to perform cardiopulmonary resuscitation (CPR) in the supine position. The patient will already have a definitive airway and intravenous access established, thereby eliminating potentially the largest drawbacks of prone CPR: the hindrance of airway and intravenous catheter acquisition. Intraoperative scenarios in which the patient is in the prone position, as in cases of spinal surgery, are unique settings for which prone CPR may be well-suited as a resuscitation technique.