A&A practice
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Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is associated with significant volume shifts and requires meticulous hemodynamic management. The conventional and arbitrary "liberal" and "restrictive" fluid regimens are now being challenged. ⋯ Herein, we describe a case in which point of care ultrasound of the carotid artery and derived parameters were used to guide intraoperative fluid management. We discuss the reliability of this technique and the potential advantages it could offer.
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Case Reports
Nebulized Nitroglycerin for Coronavirus Disease 2019-Associated Acute Respiratory Distress Syndrome: A Case Report.
We present a case where nitroglycerin tablets dissolved in saline and intravenous nitroglycerin solution were nebulized as surrogates for inhaled nitric oxide (iNO) after our iNO supply was depleted during the coronavirus disease 2019 (COVID-19) surge in New York. We gave this treatment to a COVID-19 patient with severe acute respiratory distress syndrome (ARDS) and hypercarbia. In response, the patient had immediate and clinically meaningful improvement in multiple organ systems despite no other interventions or ventilator changes.
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Burnout is a serious problem that anesthesiologists face during training and in practice. To mitigate it, experts advocate for strategies focused on enhancing individual resilience in addition to organizational change in health care systems. To catalyze this change, wellness-focused education must incorporate foundational knowledge about the science of well-being and impart skills to empower trainees to lead change in the future. We developed and implemented a longitudinal, developmental 3-year curriculum in a large anesthesiology residency program that included strategies to strengthen community-building, enhance meaning from a career in medicine, and incorporated topics focused on career and leadership development.
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A 33-year-old woman presented with fulminant eosinophilic myocarditis requiring venoarterial extracorporeal membrane oxygenation (ECMO). A computed tomography (CT) scan revealed a retroperitoneal mass that was eventually diagnosed as a pheochromocytoma. This case highlights the need for a comprehensive diagnostic workup for acute cardiomyopathy manifesting as cardiogenic shock in young patients and the benefit of early initiation of mechanical support facilitating both diagnosis and recovery.
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Case Reports
Water Accumulation in Amsorb Canister May Cause Inspiratory Flow Obstruction: A Case Report.
A patient received closed-circuit anesthesia from a General Electric Avance S/5 (GE Healthcare, Madison, WI) anesthesia machine during a robotic abdominal procedure. With return of spontaneous ventilation at the end of the procedure, the negative airway pressure alarm began to sound, and a negative airway pressure of 10-15 cm H2O was observed with each breath. ⋯ There was considerable condensation on the walls of the Amsorb canister, and on disassembly, the sponge at the bottom was wet. Experimentation with an empty canister revealed that as little as 30 mL of water in the sponge can reproduce our observations.