A&A practice
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Positive airway pressure (PAP) adherence in patients with obstructive sleep apnea (OSA) remains low despite known benefits. The postoperative inpatient period may represent a unique opportunity to address technical issues and promote self-efficacy, 2 important factors determining adherence, which may result in patients' seeking outpatient sleep medicine follow-up. We report our experience in developing a perioperative multidisciplinary intervention of reintroducing PAP therapy to nonadherent OSA patients with the intent of motivating patients to return to their outpatient sleep medicine clinics.
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Extrinsic compression of the heart consequent to intrapleural fluid is a rare cause of cardiac tamponade. Cases of massive hemothorax resulting in external cardiac tamponade due to injury of the internal thoracic artery (ITA) following blunt or penetrating trauma have been described in the literature. ⋯ It manifested as hemodynamic instability that persisted despite aggressive fluid resuscitation. Investigation with an intraoperative transesophageal echocardiogram demonstrated cardiac tamponade secondary to a massive hemothorax which resolved following surgical placement of an intercostal drain.
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Hyaline fibromatosis syndrome (HFS) is a rare autosomal recessive disorder characterized by hyaline fibrous depositions in the skin and internal organs. Contractured joints and gingival hypertrophy make airway management difficult in patients with HFS, while trunk deformities complicate surgical positioning. ⋯ Her airway was secured by awake fiberoptic intubation, and general anesthesia was maintained uneventfully. This report discusses the oldest reported patient with HFS and is the first to describe the management of epidural anesthesia in a patient with HFS.
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We describe a hepatic laceration and subsequent anterior spinal artery syndrome in a 21-year-old man, secondary to prolonged cardiopulmonary resuscitation with a Lund University Cardiac Assist System (LUCAS2) mechanical cardiac compression device. We briefly review the current literature pertaining to hepatic injury from trauma due to cardiopulmonary resuscitation. ⋯ This case highlights that intra-abdominal causes of hypotension should be considered in patients after a prolonged resuscitation attempt. Extending focused cardiac ultrasound to exclude intra-abdominal free fluid should be routinely considered in these patients.