A&A practice
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Case Reports
Early Massive Pulmonary Embolism After Total Hip Arthroplasty in a Patient With Behcet Disease: A Case Report.
Venous complications in Behcet disease (BD) affect nearly 40% of patients. We describe a woman with BD who presented with a massive bilateral pulmonary embolism 30 hours after total hip arthroplasty. The patient underwent surgical thrombectomy and venoarterial extracorporeal membrane oxygenation. ⋯ Therefore, continuation of methotrexate perioperatively should be considered in patients with BD. Systematically performing preoperative deep vein thrombosis screening should be also considered. The patient also had diabetes mellitus treated with metformin and sitagliptin preoperatively.
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Regional anesthetic blocks, especially in-dwelling catheters, are infrequently used in neonates and infants. The following report describes a neonate with a gangrenous right upper extremity requiring multiple painful debridements over several weeks. ⋯ After the initial procedures, bolus doses of a local anesthetic agent provided surgical anesthesia for dressing changes, thus obviating the need for multiple general anesthetics. This case demonstrates the potential efficacy of regional techniques to both treat pain and limit anesthetic exposures in neonates.
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An ultrasound-guided thoracic paravertebral nerve block was administered for left-sided abdominal pain. Lidocaine 0.4% (9.5 mL) was injected. ⋯ It was postulated that the local anesthetic was injected into the cyst, which communicated with the subarachnoid space. This case report demonstrates the anatomic variations of nerve root sheath cyst sites and the risk of injection into intranerve root sheath cysts during interventional procedures.
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There has been a significant shift away from epidural analgesia after radical cystectomy within an enhanced recovery program. Alternative techniques reported including continuous erector spinae plane analgesia require supplemental systemic morphine. ⋯ Median length of hospital stay was reduced by a third. The novel analgesic regimen may have the potential to enhance recovery after open radical cystectomy.
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We describe the cases of 2 patients free from mechanical ventilation after a cardiac surgery with systemic venous congestion from right ventricular (RV) failure. Management of these patients included RV preload reduction with diuretics and RV afterload reduction with inhaled pulmonary vasodilators. Noninvasive combination of inhaled epoprostenol and inhaled milrinone through the AirLife filtered nebulizer system (CareFusion) was used. Reduction of splanchnic venous congestion was assessed by Doppler portal flow pulsatility.