A&A practice
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Preoperative cardiac risk stratification algorithms typically use a Bayesian approach to identify a low-risk category group for which the outcome is unlikely to be improved by further testing. This report suggests evaluating common carotid intima-media thickness (CCIMT) as measured by ultrasound to determine whether it strengthens and optimizes perioperative Bayesian risk indices. ⋯ A website (www.suhitam.com/vascularage) designed by one of the authors (S. M.) is a useful resource.).
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Case Reports
Anesthetic Management of Posterior Sternoclavicular Joint Dislocations: A Report of 2 Cases.
Posterior sternoclavicular joint (SCJ) dislocation is a rare cause of shoulder injury that can present with life-threatening mediastinal complications. This injury most commonly occurs in adolescents and young adults, and there is a lack of anesthesia literature addressing its anesthetic implications. We present 2 cases of posterior SCJ dislocations and discuss the anesthetic management and the potential for mediastinal injuries.
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Case Reports
Postoperative Dexmedetomidine-Induced Polyuria in a Patient With Schizophrenia: A Case Report.
We present a patient with schizophrenia who developed dexmedetomidine-induced polyuria after superficial parotidectomy. Two hours after starting the dexmedetomidine infusion, urine output increased from a baseline rate of 80 mL/h to a 7-hour average rate of 400 mL/h (range, 280-560 mL/h), the serum sodium concentration increased from 132 to 139 mEq/L, and urine-specific gravity was 1.006. Following dexmedetomidine discontinuation, the urine output decreased to an average of 66 mL/h (range, 40-100 mL/h). Close monitoring of urine output and serum sodium concentration may be indicated during dexmedetomidine infusion.
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Case Reports
Epidural-Like Effects With Bilateral Erector Spinae Plane Catheters After Abdominal Surgery: A Case Report.
This case report highlights the potential for adverse effects with the erector spinae plane (ESP) blocks. ESP blocks are an alternative to the traditional epidural and paravertebral block for postoperative analgesia due to their relative technical ease and seemingly safer profile. To date, few complications have been reported from ESP blocks or catheters. Despite its distance from the epidural space, epidural-like effects may still occur with ESP catheters, such as hypotension and motor blockade, as observed in this patient after abdominal surgery.
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The acceptable platelet count for the safe provision of neuraxial anesthesia in obstetric patients is unknown. Comorbidities may sway a provider to perform neuraxial anesthesia, despite thrombocytopenia, as the putative risk of spinal-epidural hematoma may not outweigh the risks associated with general anesthesia. The case of a 22-year-old nulliparous woman undergoing a cesarean delivery with a new diagnosis of pulmonary hypertension and right heart failure, compounded with thrombocytopenia and possible Hemolysis, Elevated Liver Enzyme, and Low Platelet (HELLP) syndrome, is presented. Risks and benefits of general versus neuraxial anesthesia in this specific setting are reviewed.