A&A practice
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Case Reports
Retroperitoneal Hematoma Following Elective Abdominal Aortic Aneurysm Repair: A Case Report.
Retroperitoneal hematoma formation following elective open abdominal aortic aneurysm (AAA) repair may be occult. We report a case of recurrent hypotensive episodes in the postanesthesia care unit (PACU) that were temporarily treated successfully with fluid, blood products, and vasopressors. ⋯ Evacuation of the hematoma rapidly restored venous return and hemodynamics. This report describes a case of retroperitoneal hematoma formation and highlights challenges associated with diagnosing bleeding in this compartment.
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The coronavirus disease 2019 (COVID-19) pandemic has rapidly exposed health care system inadequacies. Hospital ventilator shortages in Italy compelled US physicians to consider creative solutions, such as using Y-pieces or T-pieces, to preclude the need to make decisions of life or death based on medical equipment availability. We add to current knowledge and testing capacity for ventilator splitters by reporting the ability to examine the functionality of ventilator splitters by using 2 high-fidelity lung simulators. Data obtained by the high-fidelity lung simulators included: tidal volume, respiratory rate, minute ventilation, peak inspiratory pressure, peak plateau pressure, and positive end-expiratory pressure.
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Midazolam is commonly used for sedation during procedures because of its relative safety and predictability. Still, some rare undesirable medication reactions have been described. ⋯ These symptoms ultimately resolved following reversal of the midazolam with flumazenil. Given the widespread and multidisciplinary use of midazolam, practitioners should be aware of the potential for rare adverse reactions and be prepared to manage these scenarios.
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Case Reports
Initiation of Cardiopulmonary Bypass in a High-Risk Patient Under Regional Anesthesia: A Case Report.
A 34-year-old man presented with a large right ventricular (RV) intracardiac mass obstructing RV inflow and outflow as well as a concomitant pericardial effusion displaying physiological signs of tamponade. The patient underwent awake femorofemoral cannulation for cardiopulmonary bypass (CPB) under regional anesthesia with initiation of CPB before induction of general anesthesia. This unconventional approach avoided hemodynamic perturbations in this high-risk patient. Regional anesthesia provided predictable analgesia compared to local infiltration for improved toleration of cannulation.
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Case Reports
Ultrasound-Guided Midpoint Transverse Process to Pleura Nerve Block for Medical Thoracoscopy: A Case Report.
We performed the midpoint transverse process to pleura (MTP) block in a patient with a recurrent pleural effusion requiring medical thoracoscopy, drainage of pleural effusion, talc poudrage, and placement of tunneled pleural catheter under sedation while in the left lateral decubitus position. Forty milliliters of a combination of bupivacaine hydrochloride and lidocaine, with dexamethasone and clonidine as adjuvants, was injected at the T6 level under ultrasound guidance with satisfactory intra- and postoperative analgesia.