A&A practice
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Case Reports
Intraoperative Diagnosis of Coronavirus Disease 2019 in an Asymptomatic Patient: A Case Report.
Patients with coronavirus disease 2019 (COVID-19) with variable clinical presentations are encountered in the perioperative setting. While some have already been diagnosed and are symptomatic, others have undiagnosed, asymptomatic COVID-19. ⋯ We report an intraoperative diagnosis of COVID-19 in an asymptomatic patient, prompted by clinical signs. To control a pandemic such as COVID-19, a high index of suspicion is pivotal when caring for asymptomatic patients in the perioperative setting.
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Complex regional pain syndrome (CRPS) can be a debilitating, persistent, and treatment-resistant pain condition. This report presents a case of severe CRPS affecting multiple limbs, resistant to standard treatment modalities. Treatment with spinal cord stimulation (SCS) had an initial good effect. ⋯ A lead fracture resulted in a rapidly developing recurrence of CRPS in the patient's arm, necessitating amputation. SCS may be an effective modality for treatment of severe CRPS. However, mechanical problems should always be considered when an SCS-implanted patient experiences rapid symptom progression or abrupt cessation of stimulation.
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Hyperbaric bupivacaine, the local anesthetic routinely selected for single-injection spinal anesthesia for cesarean delivery (CD), was in short supply in 2018. Hospital stocks were significantly less than before and after the shortage period. ⋯ Retrospective chart review revealed that elective and emergency CDs were performed without delays or increase in rate of general anesthesia during this period. However, trainees had fewer opportunities to perform spinal anesthesia for CD.
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Neuraxial analgesia has been established as the standard of care for labor analgesia. However, patients presenting with coagulopathy require anesthesiologists to explore alternate analgesic techniques. Systemic opioids may result in neonatal respiratory depression, and inhaled nitrous oxide may lead to nausea, vomiting, and over sedation and may not be readily available in all labor and delivery units. In this case report, we describe a case where posterior quadratus lumborum blocks provided effective analgesia in a parturient with Hemophilia A during the first stage of labor.
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Airway exchange catheter is a valuable tool where an airway is anticipated to be difficult to reintubate. We report a case of subcutaneous emphysema, pneumomediastinum, pneumoperitoneum, and pneumothorax after extubation using an exchange catheter. ⋯ The patient was ventilated for 2 days and then extubated without complications. Airway exchange catheter should be used cautiously with a low initial gas flow during extubation.