A&A practice
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Myocardial ischemia postarterial switch operation has been reported extensively in the literature and has been almost exclusively ascribed to issues related to coronary artery translocation. Here, we report a case of a 5-week-old child with D-transposition of the great arteries who underwent an arterial switch operation and developed myocardial ischemia after pericardial drain placement, as evidenced by significant ST segment elevation and abnormal regional cardiac wall motion. The ST segment and cardiac wall motion improved once the drain was withdrawn from the pericardium and placed in the retrosternal space. Few reports in the literature describe this complication, particularly in pediatric patients.
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Non-paresthesia-free spinal cord stimulation (PF-SCS) has been successfully used in treating central pain syndromes in multiple sclerosis (MS) patients. However, the efficacy of PF-SCS in MS is unknown. ⋯ Her concomitant central pain and spasticity failed multiple attempts of medical management despite escalating multimodal pharmacological regimens. A trial and subsequent permanent placement of dorsal column spinal cord stimulator with paresthesia-free programming was successful in managing her central pain, illustrating a potential role of PF-SCS in treating patients with MS.
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We report a 31-year-old woman with sickle beta thalassemia zero who presented at 21 weeks gestational age with multiple bilateral pulmonary emboli and no hemodynamic instability. Acquired antithrombin deficiency was suspected due to a refractory response to therapeutic anticoagulation with enoxaparin, unfractionated heparin, and fondaparinux, and a reduced antithrombin antigen level. ⋯ To avoid the use of alternative anticoagulants that may cross the placenta and impact the fetus, a planned cesarean delivery was performed without complication at 27 weeks gestation. Both mother and child experienced successful long-term outcomes.
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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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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.