A&A practice
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Temporary hypotension after severe trauma might help achieve hemostasis and increase the chances of survival. However, excessive hypotension can lead to adverse neurological sequelae or be fatal. The relationship between the degree of hypotension and neurological prognosis after trauma is not fully understood. Our report describes a patient with severe trauma who survived with a favorable neurological outcome despite extreme and prolonged treatment-resistant hypotension.
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Case Reports
Atrioesophageal Fistula After Radiofrequency Ablation Presenting With Status Epilepticus: A Case Report.
Radiofrequency (RF) ablation for atrial fibrillation is commonly performed. Atrioesophageal fistulas are an uncommon complication of RF ablation and can present with status epilepticus due to an extensive vascular air embolus. Initial treatment may require a high level of suspicion of this rare occurrence to help prevent further injury and increase the likelihood of a meaningful recovery.
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Case Reports
Bilateral Cavernous Sinus Syndrome, Pituitary Macroadenoma, and Postoperative Loss of Vision: A Case Report.
Postoperative vision loss is a rare complication. When visual loss does occur, it is rarely associated with ophthalmoplegia. ⋯ The patient underwent urgent excision of the macroadenoma 5 days after the onset of symptoms. Visual field deficits and associated ophthalmoplegia had completely resolved at 3-month follow-up.
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Hyperthyroidism during pregnancy is a relatively rare event, but poor control of hyperthyroidism during pregnancy is associated with a host of issues. These include intrauterine fetal demise, hypertensive disorders of pregnancy, preterm delivery, low birth weight, intrauterine growth restriction, and maternal congestive heart failure. ⋯ Patients who develop thyroid storm present several challenges to anesthesiologists including hemodynamic instability and medication management. Here, we present the anesthetic management for a parturient whose delivery was complicated by signs and symptoms consistent with thyroid storm.
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Anesthetic management of the adult patient with a Fontan circulation is complex and requires understanding of the specific physiology of the individual patient. Long-term survival in this cohort has increased to the point where patients are presenting for noncardiac surgery related to degenerative diseases of aging. We describe the perioperative management of a patient with a Fontan circulation undergoing total hip arthroplasty using combined spinal-epidural anesthesia and discuss the issues requiring special consideration for this surgical procedure in this group of patients.