A&A practice
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Case Reports
Nebulized Lidocaine in the Treatment of Refractory Postoperative Laryngospasm: A Case Report.
Intraoperative laryngospasm occurs in <1% of cases. Recurrent laryngospasm is rarer. ⋯ Nebulized lidocaine is used to anesthetize the vocal cords before awake fiberoptic intubation. This case highlights the novel use of nebulized lidocaine to successfully treat refractory postoperative laryngospasm in a fully conscious adult patient after conventional measures were unsuccessful.
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Dental injury is a common cause of malpractice claims involving anesthesiologists. Inadequate preoperative dental evaluations and incomplete documentation are often cited as contributing factors during reviews of closed claims. Point-of-care smartphone photographs are widely used in other medical fields such as dermatology and plastic surgery. We discuss the use of smartphone photographs for documenting preoperative dental examinations.
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Heparin is the only well-established anticoagulant medication for cardiopulmonary bypass making selecting an alternative anticoagulant challenging in patients with heparin-induced thrombocytopenia. Other anticoagulant medications can cause significant postoperative bleeding, especially in patients with end-stage renal disease. We present a case of a 63-year-old woman requiring aortic valve replacement with a history of heparin-induced thrombocytopenia and end-stage renal disease. Cangrelor and heparin were successfully used during cardiopulmonary bypass, offering an option for anticoagulation management for a uniquely challenging patient population.
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A 71-year-old man with advanced vocal cord carcinoma presented with severe airway obstruction. Therapeutic anticoagulation with enoxaparin complicated management. ⋯ Ventilation with the Ventrain device lasting 40 minutes (15 L/min, inspiration/expiration 1:1, 15 breaths/min), during IV anesthesia with muscle paralysis, resulted in excellent blood gas values until placement of the tracheal cannula. This case report highlights the effectiveness of a novel ventilation technique that should be considered as back-up when bronchoscopic intubation fails.
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Case Reports
Localized Corticosteroid Injections for Malignant Joint Pain in the Oncologic Population: A Case Series.
Pain is a common issue that is present in cancer survivors as well as those with active malignant processes. Despite opioid analgesics and adjuvant therapies such as systemic corticosteroids, many patients have persistent localized pain. ⋯ All patients reported an improvement in pain symptoms and function with no major complications. Targeted corticosteroid injections provide a potential for relief of malignant joint pain.