A&A practice
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We report the case of a 21-year-old primiparous woman at 22 weeks gestation who presented with a large uncorrected ventricular septal defect, severe pulmonary hypertension, and Eisenmenger syndrome. The patient elected for termination of pregnancy, which was performed under regional anesthesia. ⋯ Thrombocytopenia and systemic anticoagulation for extracorporeal membrane oxygenation presented a challenge for removal of the epidural catheter. Pulmonary hypertension was managed and she was discharged on postoperative day 35.
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Case Reports
In Situ Cold Perfusion of the Liver on Cardiopulmonary Bypass: Coagulopathy and Its Correction: A Case Report.
We report a case of profound coagulopathy after the dual insult of cold in-situ perfusion of the liver and cardiopulmonary bypass in a patient undergoing complex hepatobiliary and cardiovascular surgery. Management of this coagulopathy with conventional blood products was hindered by elevated venous pressures, thought to contribute to persistent bleeding and risked liver and right ventricular dysfunction, necessitating a change in strategy. Anesthesiologists should consider fluid-restrictive strategies to correct coagulopathy in combined liver and cardiac surgery.
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Case Reports
Anesthetic Considerations for a Patient With Chronic Systemic Capillary Leak Syndrome: A Case Report.
Systemic capillary leak syndrome (SCLS) is an idiopathic vascular hyperpermeability that leads to profound hypotension, hypoalbuminemia, and hemoconcentration. Sixty years since its inauguration into literature, SCLS is still elusive, underdiagnosed, and profoundly dangerous. ⋯ Both forms are postulated to have similar pathogenesis, yet clinical differences are noteworthy, warranting variations in perioperative management. We present a patient with chronic SCLS who underwent general and regional anesthesia for elective surgery.
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There have been many complications associated with transurethral resection of the prostate (TURP), known as TURP syndrome. Of the various irrigation fluids used for TURP, glycine irrigant has been historically popular given its relatively low cost. ⋯ However, there have been many case reports of central nervous system toxicity such as transient blindness and encephalopathy related to glycine toxicity. Here, we report blue vision (cyanopsia), which has never been reported as a symptom of TURP syndrome.
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Pentalogy of Cantrell is a rare syndrome consisting of midline abnormalities involving the heart, sternum, abdominal wall, and the anterior and pericardial diaphragm. This combination of defects places patients at particular perioperative risk and requires individualized management during anesthetic care. The following report documents the management of a patient with pentalogy of Cantrell, whose condition was further complicated by severe midline craniofacial abnormalities, including large anterior encephalocele, deficient mandible, tethered tongue, and cleft palate. The case offers insight into the complexity of care in this unique patient population.