A&A practice
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Case Reports
Intraoperative Coronary Artery Spasm Likely Triggered by Surgical Gallbladder Manipulation: A Case Report.
Although the association between cholecystitis and acute coronary syndrome-like symptoms, including chest pain with electrocardiogram (ECG) changes, has been reported previously, it is unclear whether these symptoms can be provoked by direct stimulation to the gallbladder. We present the case of a 44-year-old man who developed coronary artery spasm (CAS) with ST-segment-elevation followed by nonsustained polymorphic ventricular tachycardia during laparoscopic cholecystectomy. The change in ECG occurred only when the gallbladder was manipulated, suggesting that direct stimulation to the gallbladder can cause CAS. Clinicians should be aware that careful ECG monitoring is necessary, especially while the gallbladder is manipulated.
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Paratracheal air cyst encompasses conditions including tracheoceles, bronchogenic cysts, lymphoepithelial cysts, and tracheal diverticula. The occurrence of tracheal diverticulum is rare and usually does not manifest clinically or may cause symptoms like chronic cough. ⋯ It may pose diagnostic dilemmas in such cases. An understanding of the underlying mechanism helps in the management, which in majority of cases is conservative.
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Opioid-tolerant individuals have greater risk of perioperative complications and worse clinical outcomes. A preoperative screening process and structured approach to opioid-tolerant patients was developed to identify and optimize these patients before elective surgery.
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Spinal cord stimulation has been demonstrated as a therapeutic option for patients with persistent lumbar radicular pain secondary to failed back surgery syndrome. This case report demonstrates a successful percutaneous spinal cord stimulator (SCS) trial followed by surgical placement of a permanent SCS to treat lumbar radicular pain and axial low back pain in a patient with severe thoracolumbar scoliosis status after laminectomy and spinal fusion surgery. Currently, there is a paucity of literature on this topic.
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Cranial nerve (CN) VII palsy is a rare complication of neuraxial blockade. The likely etiology of the palsy is intracranial hypotension from cerebrospinal fluid loss leading to traction on CN VII. ⋯ We present a patient who had a dural puncture with development of a headache and CN VII palsy, which improved with epidural blood patch (EBP). EBP should be considered for patients with suspected CN palsy from intracranial hypotension.