A&A practice
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We present a rarely described complication of unilateral rhinorrhea and sneezing in a patient who received intravenous sedation with propofol and supplemental oxygen via a nasal cannula during upper gastrointestinal endoscopy. The literature is reviewed and a mechanism is proposed. Mechanical irritation of the nasal mucosa is felt to be the trigger. Suggestions to avoid and to treat are offered.
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Gastric ultrasound is emerging as a tool that can be used to assess gastric content and volume in patients with an unknown fasting history. This information can impact the choice of anesthetic technique or the timing of surgery due to the presumed risk of aspiration. Currently, no data are available regarding the use of gastric ultrasound for patients who have had prior gastric operations, despite the increasing number of patients undergoing bariatric surgery. Our experience suggests that a patient with a prior Roux-en-Y gastric bypass may present with altered anatomy, rendering gastric ultrasound an ineffective technique to assess the volume of ingested food or liquid.
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We report a case of cesarean hysterectomy in a parturient with morbidly adherent placenta that was complicated by an estimated blood loss of 25 L, with the usage of massive transfusion protocols. On the third postoperative day, symptomatology suggestive of a stroke was elicited. ⋯ She showed gradual recovery in the following months with almost complete return to baseline function. We present this case to highlight vertebral artery dissection as a potential complication after peripartum massive blood transfusion and to consider the management decisions this scenario presents.
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There have been many advances in the management of acute respiratory distress syndrome, a condition which Bellani et al, in the LUNG SAFE trial (Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure), found represents up to 10.4% of intensive care unit admissions and 23.4% of patients requiring mechanical ventilation, with an unadjusted intensive care unit and hospital mortality of 35.3% and 40%, respectively. Studies have shown that prone positioning can improve oxygenation in patients who are mechanically ventilated for acute respiratory distress syndrome. This case report describes an example in which intraoperative prone positioning improved oxygenation in a patient after aspiration of gastric contents on induction of general anesthesia.
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Case Reports
Exchange Autotransfusion for Rapid Correction of Hyperkalemia During Liver Transplantation: A Case Report.
A 46-year-old woman with alcoholic cirrhosis and hepatorenal syndrome requiring hemodialysis presented with hyperkalemia (5.5 mEq/L) immediately before liver transplantation. For correction of hyperkalemia, an exchange transfusion began by removing her blood into an autotransfusion system to wash out noncellular components while maintaining normovolemia. ⋯ Postreperfusion syndrome was not observed. In summary, exchange transfusion was used successfully for rapid correction of hyperkalemia, showing the value of its application in liver transplantation.