A&A practice
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Review Case Reports
Facial Petechiae Following Laparoscopic Surgery: A Case Report of Rumpel-Leede Phenomenon.
Petechial development as a result of venous compression has variously been described as acute dermal capillary rupture, mask phenomenon, and Rumpel-Leede Phenomenon. We describe the case of a patient who developed a facial petechial rash following a laparoscopic abdominal hysterectomy in steep Trendelenburg position. ⋯ These physiological effects lead to cephalad venous compression and are analogous to the venous compression caused by a tourniquet. The circumstances preceding its development and the characteristics of the facial rash lead us to conclude that the patient we present developed facial Rumple-Leede Phenomenon.
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Anesthetic management of pediatric circumcisions typically involves intravenous access and advanced airway management. We explored the use of a minimally invasive anesthetic protocol for pediatric circumcisions akin to the anesthetic management for bilateral myringotomy and tympanostomy. ⋯ The mean (standard deviation) intraoperative anesthesia time was 41.4 (5.7) minutes, and 1 patient experienced a mild intraoperative complication with emesis at induction. Pediatric circumcisions can be efficiently and safely performed with minimally invasive anesthesia.
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Cesarean deliveries are often performed with a neuraxial anesthetic technique. Fracture of needles used for local anesthetic infiltration is rare. ⋯ CSE anesthesia was then successfully performed at a different spinal interspace, and the patient had an uneventful cesarean delivery. The patient had the needle fragment removed on the first postoperative day by an interventional radiologist who used fluoroscopy to identify the needle location.
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Case Reports
Persistent Postoperative Vasoplegia After Ureteronephrectomy Due To Suspected Intravesical Gemcitabine Toxicity.
We describe a case of unusually persistent vasoplegia in the postoperative course of a patient recovering after elective right robotic nephroureterectomy with intravesical salvage gemcitabine. In the treatment of patients with intravesical adjuvant therapy, gemcitabine may precipitate persistent vasoplegia requiring further fluid resuscitative efforts, vasopressor support, and other supportive management. This potential adverse event should be considered when all common causes of persistent vasoplegia are ruled out, such as shock related to bleeding, infection, allergic reaction, or pulmonary embolic phenomenon.
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Case Reports
Severe Abdominal Wall Infection After Subcostal Transversus Abdominis Plane Block: A Case Report.
Transversus abdominis plane (TAP) blocks are increasingly used for perioperative analgesia in patients undergoing abdominal surgeries. TAP blocks are easy to perform, reliably effective, and have an excellent safety profile. Nevertheless, we report a patient who underwent an open cholecystectomy and right hemicolectomy where a subcostal TAP block possibly contributed to an unusual abdominal wall abscess that lead to a prolonged and complicated postoperative course.