A&A practice
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Hyperthyroidism during pregnancy is a relatively rare event, but poor control of hyperthyroidism during pregnancy is associated with a host of issues. These include intrauterine fetal demise, hypertensive disorders of pregnancy, preterm delivery, low birth weight, intrauterine growth restriction, and maternal congestive heart failure. ⋯ Patients who develop thyroid storm present several challenges to anesthesiologists including hemodynamic instability and medication management. Here, we present the anesthetic management for a parturient whose delivery was complicated by signs and symptoms consistent with thyroid storm.
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A young woman first diagnosed with von Hippel-Lindau disease (VHL) during pregnancy underwent an uncomplicated cesarean delivery despite having multiple classic VHL tumors, including a large cerebellopontine brain mass and vasoactive pheochromocytoma. Patients with VHL may have multiple tumors of the central nervous system and viscera that greatly impact anesthetic management. This case highlights the anesthetic considerations for a parturient with pheochromocytoma and elevated intracranial pressure, as well as the importance of a multidisciplinary team approach.
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Peripherally inserted central catheters (PICCs) are a feasible alternative to conventional central venous access. PICCs are often used perioperatively for central venous pressure monitoring and administration of vasoactive drugs especially in cancer patients. Catheter breakage and embolization are rare but potentially fatal complications, and most of the reported literature pertains to pediatric patients after medium- to long-term use. In this report, we describe a rare scenario of catheter breakage, entrapment, and embolization in a patient caused by inadvertent surgical clip and suture placement.
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Pancreaticoduodenectomy (Whipple procedure) is performed rarely in pediatric patients. We present our anesthetic management of an 18-month-old girl who underwent a Whipple procedure for a mass in the head of the pancreas that was causing obstructive cholangiopathy. We explore the differences between pediatric and adult patients presenting for Whipple procedure, with a focus on pediatric anesthetic management. Key considerations include blood and fluid management, perioperative analgesia, and postoperative care.
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Case Reports
Antiphospholipid Syndrome During Septic Shock: Hyper- or Hypocoagulability?: A Case Report.
We report the clinical case of a septic patient with antiphospholipid syndrome who developed ischemia in all 4 limbs, despite a normal systemic blood pressure. Prolonged coagulation times suggested a hemorrhagic diathesis, requiring transfusion of fresh-frozen plasma and discontinuation of heparin infusion. ⋯ This observation led to the reintroduction of heparin with improvement in the patient's laboratory findings. Anesthesiologists should consider thromboelastography to correct coagulopathies in patients with septic shock in the presence of antiphospholipid antibodies.