A&A practice
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Pain control after total hip arthroplasty in sickle cell patients is challenging yet essential to prevent sickle cell crises or protracted hospital stays. We present a case of effective analgesia that lasted for weeks in a young opioid-tolerant female. ⋯ Postoperatively, the patient's opioid demand was unchanged from her preoperative baseline. She met all the discharge requirements, including physical therapy targets, on postoperative day 2 and did not have any complications during the hospitalization.
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Review
Anesthesia in Patients With Multiple-System Atrophy: A Narrative Review and Practice Guidance.
Multiple-system atrophy, a rare adult-onset neurodegenerative disease, is associated with autonomic dysfunction, features of parkinsonism, and cerebellar ataxia. This article discusses multiple-system atrophy pathophysiology, clinical presentation, and perioperative issues pertinent to anesthesia.
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A 52-year-old patient was scheduled for a cystoscopy. Anesthesia was induced by intravenous injection of fentanyl and propofol. After administration of atracurium, he became bradycardic and suffered a cardiac arrest. ⋯ The postmortem found no pathology. However, mast cell tryptase was raised significantly, indicating fatal anaphylaxis. Having presented no classic clinical signs, this case is a reminder that rapid cardiovascular collapse can be the sole clinical feature of anaphylaxis.
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Bardet-Biedl syndrome is a rare autosomal recessive genetic disorder that affects many organ systems. In cases of Bardet-Biedl syndrome, since the risk of developing inspiratory, cardiovascular, and metabolic problems is high, endotracheal intubation and anesthesia management are difficult. In this report, we present our experience in the management of anesthesia during endoscopic sinus surgery that was performed for the first time on a 6-year-old pediatric patient diagnosed with Bardet-Biedl syndrome.
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Upper airway obstruction during anesthesia is the leading cause of complications during sedation, intubation, and emergence. Devices to support oxygenation and ventilation are costly, require capital equipment, and cannot be used during transport. ⋯ The SuperNO2VA nasal mask provided high-flow nasal oxygen and positive pressure during awake fiberoptic intubation and on extubation, maintaining airway patency in the operating room, during transport, and in recovery. The SuperNO2VA is inexpensive and portable and should be considered for high-risk patients with difficult airways.