A&A practice
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Spontaneous coronary artery disease is an uncommon and likely underdiagnosed cause of sudden cardiac death affecting typically young and middle-aged women. We report a case of spontaneous coronary artery disease in the postoperative period in a female patient who developed an acute coronary event after gynecologic surgery. The patient was clinically asymptomatic except for mild hemodynamic instability and ST-segment-elevation myocardial infarction seen on electrocardiogram. Spontaneous coronary artery disease was diagnosed with coronary angiography, and a pharmacological therapy was instituted with favorable results.
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Congenital hernias, frequently misdiagnosed during pregnancy, are potentially fatal and require prompt repair. A pregnant woman with medical history of repaired congenital hernia was admitted with misdiagnosis of preeclampsia. Physical examination and chest x-ray revealed a Bochdalek hernia. ⋯ A multidisciplinary team was present in the operating room. All monitoring catheters were placed in advance in the intensive care unit. During recovery, the patient experienced ventricular fibrillation, presumed to be a manifestation of takotsubo syndrome, which responded favorably to cardiopulmonary resuscitation.
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Intravenous lidocaine is increasingly being utilized as an opioid-sparing analgesic. A 55-year-old man with well-controlled human immunodeficiency virus on highly active antiretroviral therapy was prescribed a lidocaine infusion at 1 mg/kg/h for postoperative pain. On postoperative day 2, the patient experienced 4 unresponsive episodes with tachycardia, hypertension, and oxygen desaturation. ⋯ There is significant pharmacokinetic interaction between lidocaine and this patient's human immunodeficiency virus medications. This case highlights the need for a readily accessible list of medications that caution against lidocaine. We propose in-house serum lidocaine levels to monitor patients at an increased risk for toxicity.
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Pericarditis is a source of chest pain that can be chronic and debilitating. We describe a patient diagnosed with pericarditis with chest pain refractory to medical management. ⋯ Possible reasons for this result may include incomplete transection, a significant contribution of pain signaling from the phrenic and/or vagus nerve, or nerve regeneration. Literature describing these interventional techniques for pericardial pain is sparse, and more research is needed to determine their efficacy in refractory pericardial pain.
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Case Reports
Anesthetic Considerations in Saul-Wilson Syndrome, a Rare Skeletal Dysplasia: A Case Report.
Saul-Wilson syndrome, also known as microcephalic osteodysplastic dysplasia, is a rare type of dwarfism with significant anesthetic considerations. The genetic defect is associated with nearly uniform micrognathia, odontoid hypoplasia, and possible cervical spine instability that contribute to potentially increased risk of airway complications. Herein, we describe the anesthetic management of a 2-year-old child with Saul-Wilson syndrome.