A&A practice
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There have been many complications associated with transurethral resection of the prostate (TURP), known as TURP syndrome. Of the various irrigation fluids used for TURP, glycine irrigant has been historically popular given its relatively low cost. ⋯ However, there have been many case reports of central nervous system toxicity such as transient blindness and encephalopathy related to glycine toxicity. Here, we report blue vision (cyanopsia), which has never been reported as a symptom of TURP syndrome.
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Isaacs syndrome is a rare peripheral nerve hyperexcitability syndrome. The painful discharges in Isaacs syndrome are abolished by the blockade of the neuromuscular junction but not by peripheral nerve blocks (PNB). However, the efficacy of PNB for intraoperative and postoperative analgesia among those with Isaacs syndrome is unknown. ⋯ The patient required only a single low dose of rocuronium for intubation and surgery. On emergence from anesthesia, the patient was pain free for 6 hours and did not return to her preoperative pain state for 36 hours. PNB can be an effective means of postoperative pain control for patients with Isaacs syndrome.
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Tardiness in the operating room has been shown to decline in the day as a result of operational decisions on the day of surgery. This article studies nonoperating room anesthesia (NORA) tardiness at the University of Vermont Medical Center in cases performed in the 2015 calendar year. ⋯ On average, tardiness in NORA sites increased as the day progressed, with the exception of diagnostic radiology. This is likely due to limited tactical and operational opportunities to improve workflow.
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We report the case of a 21-year-old primiparous woman at 22 weeks gestation who presented with a large uncorrected ventricular septal defect, severe pulmonary hypertension, and Eisenmenger syndrome. The patient elected for termination of pregnancy, which was performed under regional anesthesia. ⋯ Thrombocytopenia and systemic anticoagulation for extracorporeal membrane oxygenation presented a challenge for removal of the epidural catheter. Pulmonary hypertension was managed and she was discharged on postoperative day 35.
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Chest tube thoracostomy is a commonly performed procedure in the emergency department, operating room, and intensive care unit. We report an extremely rare case of accidental insertion of a chest tube into the left atrium via the right pulmonary vein during an interventional radiology-guided placement of the catheter. To our knowledge, such a case has not been reported to date. The anesthetic and surgical management of this injury are discussed.