A&A practice
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We report a case of cesarean hysterectomy in a parturient with morbidly adherent placenta that was complicated by an estimated blood loss of 25 L, with the usage of massive transfusion protocols. On the third postoperative day, symptomatology suggestive of a stroke was elicited. ⋯ She showed gradual recovery in the following months with almost complete return to baseline function. We present this case to highlight vertebral artery dissection as a potential complication after peripartum massive blood transfusion and to consider the management decisions this scenario presents.
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Case Reports
Exchange Autotransfusion for Rapid Correction of Hyperkalemia During Liver Transplantation: A Case Report.
A 46-year-old woman with alcoholic cirrhosis and hepatorenal syndrome requiring hemodialysis presented with hyperkalemia (5.5 mEq/L) immediately before liver transplantation. For correction of hyperkalemia, an exchange transfusion began by removing her blood into an autotransfusion system to wash out noncellular components while maintaining normovolemia. ⋯ Postreperfusion syndrome was not observed. In summary, exchange transfusion was used successfully for rapid correction of hyperkalemia, showing the value of its application in liver transplantation.
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Autosomal dominant or benign osteopetrosis is a rare genetic disorder of osteoclasts that results in dense but brittle bone structures. Patients with osteopetrosis may be scheduled for total knee arthroplasty to treat painful and functionally limiting osteoarthrosis. A search of the published literature produced no citation concerning anesthesia for patients with autosomal dominant osteopetrosis undergoing total knee arthroplasty. We present a case report detailing our experience and discuss considerations for the care of future patients with autosomal dominant osteopetrosis.
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We report the case of a 60-year-old man who underwent open radical prostatectomy for prostate adenocarcinoma. He had no known cardiac disease or symptoms other than controlled hypertension and remote history of cocaine use. ⋯ Subsequent cardiac workup showed no abnormalities. We believe the cause of arrest was sugammadex, considering the time of administration, the absence of cardiac disease, and stable operative course.
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As technology progresses, our clinical treatment options rise steadily. We are comfortable now with the handling of ready-to-use high-quality videolaryngoscopes and fiber optics, and there is increasing knowledge and practice that the combination of these 2 techniques has a high "rescue rate" in situations when fiber-optic intubation or videolaryngoscopic intubation fails. Therefore, we would recommend to specifically include this technique in the "difficult airway algorithm-nonemergency pathway," so it comes routinely into mind when faced with a "can ventilate, but cannot intubate" situation that warrants intubation for the surgical operation.