A&A practice
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Review Case Reports
Cardiac Arrest Following Remimazolam-Induced Anaphylaxis: A Case Report.
Remimazolam is a recently approved benzodiazepine sedative. We report a case of a 72-year-old man who experienced a cardiac arrest due to severe anaphylaxis immediately after general anesthesia induction. ⋯ Although remimazolam is structurally similar to midazolam, the patient was not allergic to midazolam as demonstrated before and after anaphylaxis. This report highlights the potential risk of allergic reactions to remimazolam.
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Review Case Reports
Facial Petechiae Following Laparoscopic Surgery: A Case Report of Rumpel-Leede Phenomenon.
Petechial development as a result of venous compression has variously been described as acute dermal capillary rupture, mask phenomenon, and Rumpel-Leede Phenomenon. We describe the case of a patient who developed a facial petechial rash following a laparoscopic abdominal hysterectomy in steep Trendelenburg position. ⋯ These physiological effects lead to cephalad venous compression and are analogous to the venous compression caused by a tourniquet. The circumstances preceding its development and the characteristics of the facial rash lead us to conclude that the patient we present developed facial Rumple-Leede Phenomenon.
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Review Case Reports
Unusual Manifestations of the Trigeminocardiac Reflex During Awake Craniotomy: A Case Report and Review of the Literature.
The trigeminocardiac reflex (TCR) is triggered by stimulation of a branch of the trigeminal nerve and results in vagally mediated bradycardia, hypotension, apnea, and gastrointestinal hypermotility. In the operating theatre, patients susceptible to TCR are typically under general anesthesia; thus, cardiac abnormalities are the most common manifestation. Our case highlights the less common intraoperative manifestations of gastric hypermotility and apnea in a patient undergoing awake craniotomy for tumor resection. Prompt recognition, removal of stimuli, and airway management prevented catastrophic complications while facilitating completion of the procedure.
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Review Case Reports
Transesophageal Echocardiography in Patients With Magnetic Gastroesophageal Reflux Devices: A Report of 2 Cases.
Magnetic gastroesophageal reflux devices are becoming a common treatment option for reflux refractory to medical therapy. These devices are inserted laparoscopically with successful outcomes; however, patients may still complain of dysphagia after implantation. ⋯ However, we present 2 cases where intraoperative TEE was performed in patients with reflux devices without complication or image degradation. The described cases, in addition to a review of the perioperative management of these devices, support the use of TEE in this patient population.
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Flecainide is a first-line antiarrhythmic drug used to treat atrial arrhythmias and/or supraventricular tachycardia in those without coronary artery disease or structural heart disease. Even though it is an older antiarrhythmic, flecainide accounted for 1.6 million prescriptions in the United States in 2016, and its utilization is generally increasing. Despite its popularity, flecainide may predispose patients to rapid atrial flutter with resultant hemodynamic compromise, particularly in the physiologically stressful perioperative period. This article reviews the pharmacology of flecainide, describes problematic arrhythmias that may arise specifically during flecainide use, and offers recommendations for perioperative flecainide management.