A&A practice
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Aromatic L-amino acid decarboxylase deficiency (AADCD) is a rare autosomal recessive disorder of neurotransmitter synthesis with lack of sympathetic autoregulation. Owing to hemodynamic regulatory dysfunction and impairment of sympathetic regulation of heart rate, anesthesia is challenging. ⋯ Neuraxial anesthesia was administered, as she had not developed complications previously. Thus, neuraxial anesthesia can also be used safely for a cesarean delivery with appropriate anticipation of potential autonomic disturbances and lack of adrenergic neurotransmission.
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Ambiguity in defining difficult intubation involving video laryngoscopy (VL) may pose potential risks to patients. To improve airway documentation practices, we surveyed anesthesia providers on their difficult intubation interpretations and VL use. ⋯ These results suggest that clinicians inconsistently interpret difficult intubations, especially in cases involving VL. There is a need for provider education and standardization of airway documentation, inclusive of VL.
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Complex regional pain syndrome (CRPS) has the potential to spread from the initial site to distant areas of the body. However, there is a paucity of data reporting the patterns and underlying cause of the spread. This case describes spontaneous, ipsilateral spread of CRPS from the right lower extremity to the orbit, leading to corneal abrasion.
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Surgical resection of arteriovenous malformations (AVMs) is indicated in the presence of life-threatening and severe morbidity, including symptomatic heart failure, ischemic pain, and recurrent bleeding, where other less invasive treatment strategies have been unable to halt the progression of disease. We present the challenges encountered in the perioperative care of a 23-year-old man with high output cardiac failure, gangrenous hand, and severe chronic pain undergoing shoulder disarticulation for a high-flow complex AVM of the upper limb.