A&A practice
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Case Reports
Awake Intubation via an Ambu AuraGain in a Patient With Extreme Obesity: A Case Report.
Severe obesity is associated with increased morbidity and mortality. Airway management is challenging due to difficulties in positioning and airway management and altered pulmonary physiology. ⋯ The procedure was well tolerated and easily performed in the full sitting position for optimal airway and ventilation and cardiovascular stability during intubation. To our knowledge, this is the first published report of awake flexible bronchoscopic intubation via an AuraGain, and we discuss our rationale for using this technique.
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Case Reports
Titration of Bivalirudin Infusion in the Pediatric Cardiac Catheterization Laboratory: A Case Report.
Bivalirudin is a direct thrombin inhibitor that is used as a procedural anticoagulant during percutaneous coronary interventions and cardiac surgery for patients with heparin-resistant thrombosis or heparin-induced thrombocytopenia. There is a robust literature describing its safety and efficacy in adults; however, its use in the pediatric population is relatively rare, with dosing extrapolated from adult data. In this case report, we describe a 4-year-old with complex congenital heart disease and history of heparin-induced thrombocytopenia who required bivalirudin dose uptitration during cardiac catheterization.
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Case Reports
Diagnosis of an Additional Ventricular Septal Defect by Observing Dark Blood in Aortic Root Vent: A Case Report.
Diagnosis and management of multiple ventricular septal defects still remain a challenging task. Although many new diagnostic modalities have been used for the perioperative diagnosis of ventricular septal defects, the discovery of residual or additional shunts in the postoperative period is not uncommon. We report a case where we observed an undiagnosed additional ventricular septal defect shunting deoxygenated dark blood into the aortic root vent during deairing of the heart, which was confirmed on transesophageal echocardiography and addressed with reinstitution of cardiopulmonary bypass.
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Cardiac disease is one of the leading causes of maternal mortality in developed countries. The presence of a mechanical valve is a predictor of cardiac complications in obstetric patients, likely due to the challenges associated with pregnancy hypercoagulability and the imperative of meticulous management of anticoagulation throughout pregnancy, delivery, and the postpartum and to prevent the devastating event of a mechanical valve thrombosis. We report on the management of a pregnant woman with a mechanical aortic valve found to have a thrombus at 37 weeks gestation. It was decided to perform cesarean delivery to allow for a reoperative mechanical aortic valve replacement 24 hours thereafter.
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Sacroiliac joint pain is one of the most common causes of low back pain in pregnant women. We present a case of a 30-year-old G2P1 at 20 weeks gestation presenting with intractable low back pain refractory to conservative management. ⋯ We elected to do an ultrasound-guided sacroiliac joint injection that significantly abated her pain. This article aims to review the diagnosis, pathophysiology, and treatment approaches to adequately manage sacroiliac joint pain in pregnant women.