A&A practice
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Intravenous infusion of a subanesthetic dose of ketamine has been shown to improve neuropathic pain. However, ketamine-induced liver injury can occur. ⋯ Furthermore, drug-induced liver injury can cause acute liver failure. Therefore, we recommend close monitoring of liver enzymes every 1 to 2 days during ketamine infusions.
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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
E-cigarette, or Vaping, Product Use-Associated Lung Injury-Lessons Learned: A Case Series.
E-cigarette, or vaping, product use has been declared an epidemic, and a new disease has emerged from their use. We describe 4 patients with significant acute lung injury related to e-cigarette use who underwent bronchoscopy and bronchoalveolar lavage. All cases posed anesthetic challenges, including increased airway reactivity, hypoxia, increasing oxygen requirements, and, in 2 severe cases, the need for continued postprocedural mechanical ventilatory support. It is imperative that all members of the treating team are aware of the disproportionate risk of respiratory complications to anticipate the possible need for increased postprocedural respiratory support.
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Approximately 30% of health care workers (HCWs) fail the respirator fit test. Evidence suggests that addressing face leaks in the 3M respirator enhances its fit and improves its efficacy. ⋯ Sixty-eight percent of HCWs who failed the fit test with their first-choice respirator passed with a modified adhesive respirator. To increase the efficacy and safety of 3M respirators, ineffective face seals need substantial improvement in design.
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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.