A&A practice
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Infection with either mobilized colistin resistance-1 gene-positive gram-negative bacteria or invasive Candida lusitaniae occurs rarely throughout the United States. Here we report the existence of both invasive infections occurring in a single, complex patient who initially presented with necrotizing pancreatitis and gastrointestinal bleeding. We detail the patient's history and perioperative course for enterocutaneous fistulae takedown and ureteral stenting, describe a template of preventative steps taken in the perioperative environment to prevent nosocomial pathogen transmission, and provide a brief overview of both the mobilized colistin resistance-1 gene and C lusitaniae.
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Case Reports
Anesthesia Experience for Tonsillectomy in a Patient With Hypofibrinogenemia: A Case Report.
A 26-year-old male patient with hypofibrinogenemia was scheduled to undergo tonsillectomy. Hypofibrinogenemia, defined as low plasma fibrinogen (Fbg) concentration, is a type of congenital Fbg deficiency and is a rare coagulopathy. ⋯ In this case, failure to replenish Fbg during the postoperative period may have caused the postoperative hemorrhage. Considering the half-life of Fbg (3-4 days), the plasma Fbg concentration should be monitored for ≥6 postoperative days, aiming at a target level of 50 mg/dL during the postoperative period.
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Dual epidural catheter (DEC) therapy improves postoperative pain control in scoliosis correction surgery, esophagectomies, and labor. Reports about the use of a second epidural catheter to improve pain control after abdominal surgeries are sparse. ⋯ In both patients, the addition of the second catheter led to improved pain control and mobility and reduced side effects from adjuvant intravenous analgesics. DEC therapy merits consideration as an additional tool for managing postoperative pain after large abdominal surgeries despite existing incomplete epidural analgesia.
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Acute porphyria is a group of rare disorders in the biosynthesis pathway of heme that can result in severe neurovisceral attacks leading to morbidity and mortality. Perioperative complications have been largely prevented due to avoidance of precipitants and early treatment of symptoms. ⋯ This case illustrates a porphyria attack precipitated by prolonged cardiopulmonary bypass that manifested as postoperative delayed emergence, failure to wean from mechanical ventilation, autonomic insufficiency requiring significant vasoactive agents, and, ultimately, failure to thrive. The patient passed after withdrawal of care.