A&A practice
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Case Reports
Navigating Goals of Care While Confronting an Urgent, Difficult Intubation: A Case Report.
Urgent airway management is challenging because time constraints limit thorough evaluation and planning before endotracheal intubation. In this report, we describe a case in which an airway history review revealed extraordinarily complex airway anatomy that led to a decision not to attempt intubation in a man with end-stage chronic obstructive pulmonary disease. ⋯ We discuss the importance of a multidisciplinary approach that includes the patient, their family, and consultants when high-risk intubation is contemplated. The ethical role of the anesthesiologist is also discussed.
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Case Reports
Complete Nephrogenic Diabetes Insipidus After Prolonged Sevoflurane Sedation: A Case Report About 3 Cases.
Volatile anesthetic agents, such as sevoflurane, are increasingly used for long-term sedation in intensive care units worldwide, with improved clinical outcomes reported in recent studies due to favorable pharmacological properties. Despite possible renal toxicity related to the production of plasma inorganic fluoride and concerns related to reversible impairment of renal concentrating abilities, renal injury associated with sevoflurane sedation has rarely been reported in the intensive care unit setting. We hereby report 3 cases of nephrogenic diabetes insipidus associated with prolonged sevoflurane sedation using the AnaConDa device and review the possible mechanisms of renal toxicity.
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Pain control after total hip arthroplasty in sickle cell patients is challenging yet essential to prevent sickle cell crises or protracted hospital stays. We present a case of effective analgesia that lasted for weeks in a young opioid-tolerant female. ⋯ Postoperatively, the patient's opioid demand was unchanged from her preoperative baseline. She met all the discharge requirements, including physical therapy targets, on postoperative day 2 and did not have any complications during the hospitalization.
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Acute fatty liver of pregnancy is one of the most common causes of fulminant hepatic failure. A 28-year-old G3P1L1A1 presented at 37 weeks with diagnosis of acute fatty liver of pregnancy with grade 3 hepatic encephalopathy. ⋯ We applied these blocks, supplemented with intravenous ketamine for breakthrough visceral pain, to conduct cesarean delivery with a favorable outcome. Thus, transversus abdominis plane with ilioinguinal-iliohypogastric is a viable alternative in patients where general and neuraxial anesthesia is unsafe.