A&A practice
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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.
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Dorsal root ganglion stimulation (DRG-S) has shown promise as a treatment for low back pain. The traditional anterograde placement of DRG-S leads can be challenging in patients with anatomical changes from prior back surgery. ⋯ At long-term follow-up, the patients experienced substantial pain relief and improvement in quality of life, with no complications. The outside-in lead placement technique may be an efficacious alternative to the traditional techniques in patients with anomalous anatomy from prior surgery.
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We report for the first time therapy-resistant hypernatremia (plasma sodium concentration ≥150 mmol per liter) developing in 6 of 12 critically ill coronavirus disease 2019 (COVID-19) patients age 57-84 years requiring mechanical ventilation. There was no correlation between plasma sodium concentrations and sodium input. ⋯ These findings are consistent with abnormally increased renal sodium reabsorption, possibly caused by increased angiotensin II activity secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced downregulation of angiotensin-converting enzyme 2 (ACE2) receptors. As hypernatremia was associated with increased length of intensive care unit stay, special attention should be paid to the electrolyte status of COVID-19 patients.