A&A practice
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Case Reports
Epidural Blood Patch for Postdural Puncture Headache in a Patient With Coronavirus Disease 2019: A Case Report.
The safety of epidural blood patch in patients with coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unknown. Here, we report a single case of epidural blood patch to treat a postdural puncture headache in a woman after spinal anesthesia for cesarean delivery. The patient's headache was relieved, and she did not develop any other neurological symptoms.
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Case Reports
An Unresponsive Patient in Postanesthesia Care Unit: A Case Report of an Unusual Diagnosis for a Common Problem.
An unresponsive patient in the postoperative period is a serious complication that can be caused by anesthetics. However, nonanesthetic causes should also be considered. ⋯ We further describe a systematic approach to the unresponsive patient in the postanesthesia care unit (PACU). While not an uncommon occurrence, catatonia is a complex psychomotor syndrome that can be difficult to diagnose; however, catatonia should be considered in unresponsive postoperative patients.
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Case Reports
Intraoperative Diagnosis of Subaortic Stenosis in a Young Patient Scheduled for Elective Aortic Valve Replacement.
A 25-year-old patient with a history of aortic stenosis due to presumed bicuspid aortic valve presented for elective aortic valve replacement. Intraoperative transesophageal echocardiography (TEE) revealed a trileaflet aortic valve but detected the presence of a subvalvular membrane. ⋯ Successful resection resulted in relief of the obstruction. Compared with preoperative transthoracic echocardiography, TEE was able to correctly characterize the nature of the stenosis with area determination accurately provided by application of 3D techniques.
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Case Reports
Perioperative Echocardiography to Confirm Correct Central Venous Catheter Placement: A Case Report.
Central venous catheterization is widely regarded as a safe procedure by anesthesiologists and intensivists, but insertion complications and catheter malposition remain challenges for the clinicians performing central venous catheter (CVC) insertion. We report a case in which a right internal jugular CVC was inserted under ultrasound guidance and was found to be malpositioned after sternotomy into an anomalous posterior thymic vein. Therefore, we recommend confirming the correct position of CVC with transesophageal echocardiography if such is indicated for the perioperative period and emphasize the importance of a correct J-tip of the guidewire when placing a CVC.
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Case Reports
A Tale of 2 Tubes for Emergency Management of Airway Obstruction From an Anterior Mediastinal Mass: A Case Report.
Anterior mediastinal masses are challenging. As induction of general anesthesia may result in complete airway obstruction or hemodynamic collapse, maintaining spontaneous ventilation and advancing the endotracheal tube (ETT) distal to the mass are recommended. ⋯ Despite maintaining spontaneous ventilation, airway obstruction persisted following placement of the ETT proximal to the obstruction. After advancing the ETT into the right mainstem bronchus distal to the mass, hypoxemia persisted, prompting placement of a second ETT into the left mainstem bronchus to overcome the obstruction and provide adequate oxygenation.