A&A practice
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Local anesthetic toxicity is a rare but serious complication of local anesthetic administration. Although lidocaine has a safety profile superior to other amide local anesthetics, we report a case of cardiac arrest after intranasal injection of lidocaine. ⋯ Resuscitative efforts were unsuccessful until a bolus of intralipid was given. This case emphasizes that even a "low" dose of a less lipophilic drug has the potential for severe toxicity.
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Case Reports
Cerebral Oximetry Fails as a Monitor of Brain Perfusion in Cardiac Surgery: A Case Report.
Cerebral oximetry is commonly being advocated as a monitor for regional cerebral tissue oxygenation during cardiac surgery. We have increasing concern about the accuracy of this monitor, including the current systems entering the market, with new probes and algorithms. ⋯ In the current form, cerebral oximetry may at best be an expensive tool without any benefit on outcomes. In addition, it may contribute to misleading and confusing clinical data.
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Transnasal humidified rapid-insufflation ventilatory exchange is a recently described technique for safer management of difficult airways and a novel ventilation technique under anesthesia. Its full potential in patient safety and benefits are still being investigated. ⋯ However, we advocated deep IV sedation with transnasal humidified rapid-insufflation ventilatory exchange. Oxygenation was maintained without airway obstruction and pulmonary complications during the entire procedure of 110 minutes.
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Local anesthetics are used throughout the health care system. In the perioperative setting and in other settings of exposure to local anesthetics, true allergy is reported very rarely. ⋯ This case illustrates that lidocaine may be a "hidden allergen" in the perioperative setting and should always be considered a potential culprit in cases of suspected perioperative hypersensitivity. The case also demonstrates that suspected perioperative hypersensitivity requires highly specialized investigation and close collaboration between allergists and anesthesiologists.
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Mirror syndrome is a rare pregnancy complication, life-threatening to mother and fetus. Increasing survival rates of congenital heart disease into reproductive age mean that complications like Mirror syndrome in this population may be more challenging to diagnose, given overlapping signs of edema in cases of heart failure exacerbation. ⋯ A cesarean delivery under neuraxial anesthesia was performed. We review the clinical manifestations of Mirror syndrome and discuss anesthetic and obstetric management considerations for this condition.