A&A practice
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Case Reports
Transesophageal Echocardiography-Guided Cardiopulmonary Resuscitation After Rocuronium Anaphylaxis.
Anaphylaxis is a life-threatening hypersensitivity reaction that can quickly progress to circulatory collapse, even in the presence of timely epinephrine administration. This report describes a case of rocuronium anaphylaxis which progressed to circulatory arrest despite intravenous epinephrine and crystalloid resuscitation. Transesophageal echocardiography performed during cardiopulmonary resuscitation enabled rapid identification of the cause of shock and redirected management to prioritize further fluid administration, leading to return of spontaneous circulation with a good outcome. The etiology of shock in anaphylaxis can be variable, and transesophageal echocardiography can rapidly identify the likely mechanism and guide treatment without interrupting ongoing resuscitative efforts.
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Awake endotracheal intubation is the technique of choice to secure the airway when both mask ventilation and intubation are anticipated to be difficult. We present a case of a patient with a known difficult airway, bronchopleural fistula (BPF), and acute respiratory distress syndrome (ARDS) who was intubated with a double-lumen endotracheal tube (DL ETT) under awake condition using a videolaryngoscope. ⋯ The patient was treated successfully for ARDS and discharged home. To our knowledge, this is the first reported case of successful videolaryngoscope-assisted DL ETT intubation in an awake patient.
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We present the case of a patient with a subcutaneous implantable cardioverter-defibrillator (S-ICD) in situ. Device interrogation and reprogramming were unsuccessful due to a software mismatch between the device and programmer. ⋯ The S-ICD has unique perioperative considerations for the anesthesiologist. This case provides an example of the complexity of electrophysiologic devices in current use and the necessity of the anesthesia provider to stay up to date with evolving device management strategies.
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A 69-year-old man underwent total laryngopharyngectomy with radial forearm free flap reconstruction. He had lost 15 kg over a period of 6 months and did not receive any preoperative nutritional workup or management. ⋯ Diagnostic workup only revealed hypoalbuminemia and hypoproteinemia. We hypothesized relative overdosage of sedative anesthetic drugs due to preoperative malnutrition accentuated by intraoperative fluid administration.
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Case Reports
Iatrogenic Aortic Intramural Hematoma: Guidance to Intraoperative Decision Making: A Case Report.
Aortic intramural hematoma (IMH) is a collection of blood within the aortic wall without an identifiable intimal tear. It belongs to the spectrum of acute aortic syndrome (AAS) which also includes aortic dissection (AD), a well-defined entity. ⋯ But with recent advances in imaging, certain features of IMH have been identified that affect the natural course of IMH. We report a unique case of iatrogenic IMH complicating a routine coronary artery bypass graft surgery (CABG) and how imaging guided intraoperative decision making toward conservative management.