A&A practice
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We report a case of a patient who had a coronary angioplasty and received heparin, clopidogrel, and ticagrelor on the evening of bilateral total knee arthroplasties performed under combined spinal epidural anesthesia. After a multidisciplinary meeting, the epidural catheter was removed 5 days after the dose of clopidogrel. ⋯ Removing an epidural catheter in a patient on antiplatelet therapy must be done after a risk-benefit assessment, multidisciplinary collaboration, and stringent neurologic monitoring. The focus should be on prevention of a spinal hematoma, and rapid diagnosis and treatment to optimize the neurologic outcome.
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A 62-year-old male patient presented for cataract surgery under retrobulbar block anesthesia. After the regional block, the patient exhibited sudden onset and progressive symptoms of nausea, vomiting, central-type vertigo, and hearing loss. ⋯ This report demonstrates a combination of auditory and vertiginous symptoms after a retrobulbar block. It emphasizes continuous care and vigilance when using regional anesthesia due to the potential risks and varied complications.
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Remimazolam is a new ultrashort-acting benzodiazepine sedative, the use of which has not been reported for pediatric cardiac surgery. This case report describes the use of remimazolam in a 6-year-old girl who underwent minimally invasive cardiac surgery with right-sided thoracotomy for an atrial septal defect. ⋯ The patient awoke and was extubated promptly after surgery, without any serious adverse events, including intraoperative awareness. Remimazolam may be a viable option for general anesthesia during pediatric cardiac surgery.
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Case Reports
Wireless Interrogation During Cardiac Surgery For a Patient With Aveir Leadless Pacemaker: A Case Report.
Intraoperative wireless interrogation is a useful monitoring method for the leadless pacemaker (LP); however, there are few reports on this technique. A 60-year-old woman underwent cardiac surgery 24 days after Aveir LP implantation. Considering the risk of intraoperative device dislodgment and pacemaker malfunction due to electromagnetic interference, the LP was monitored by wireless interrogation via body-surface electrodes, and no device dislodgement or pacemaker malfunction was observed during surgery. Our findings suggest that wireless interrogation using body-surface electrodes on the chest is a practical and valuable monitoring technique in open-heart surgery, which lends additional safety to anesthetic management.
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Case Reports
Diagnostic and Therapeutic Ilioinguinal and Iliohypogastric Nerve Blocks: A Case Report.
We present a case report of a consult for a gynecologic patient who presented with unrelenting postsurgical pain and previously underwent laparoscopic surgery. Given the pain distribution, we hypothesized the patient had an ilioinguinal or iliohypogastric nerve entrapment injury. ⋯ The patient returned to the operating room to release a fascial stitch, permanently relieving the pain. This is a reminder that anesthesiologists can use regional anesthesia for both diagnosis and treatment.