A&A practice
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Case Reports
Linezolid-Induced Lactic Acidosis Sets Stage for Surgery to Rule Out Mesenteric Ischemia: A Case Report.
An 81-year-old woman with extensive peripheral vascular and coronary artery disease was admitted to the intensive care unit with a deep heel abscess and urinary tract infection. When cultures from the heel ulcer yielded vancomycin-resistant enterococci, she was started on the antibiotic linezolid. ⋯ Findings from the laparotomy were negative, and after elimination of other differential diagnoses, the metabolic acidosis was ultimately attributed to linezolid. Acidosis resolved after discontinuation of linezolid.
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Fasting guidelines are used to prevent perioperative aspiration but they are only reliable in healthy elective patients. Point-of-care gastric ultrasound allows qualitative and quantitative evaluation of gastric contents at the bedside. This case report describes the use of serial gastric point-of-care ultrasound to evaluate the effect of prokinetic therapy with domperidone and erythromycin in an elective surgical patient with multiple comorbidities who presented with a full stomach.
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Case Reports
Perioperative Extracorporeal Cardiopulmonary Resuscitation: The Defibrillator of the 21st Century?: A Case Report.
Veno-arterial-extracorporeal membrane oxygenation (ECMO) for cardiopulmonary resuscitation (ECMO-CPR) has been recommended by new resuscitation guidelines in the United Kingdom. Our recently established yet unfunded ECMO-CPR service has thus far treated 6 patients, with 3 making a good recovery. ⋯ We argue for a pragmatic approach to funding of ECMO-CPR because observational evidence suggests superiority over traditional resuscitation and there exists major methodological and ethical barriers to randomized controlled studies. We also call for high-quality observational evidence in the perioperative setting.
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A 2-month-old girl with abnormal facial features and malnutrition presented for placement of a gastrostomy tube. The surgery was performed under general anesthesia using a laryngeal mask airway (LMA); however, after removal of the LMA, the patient had recurrent airway collapse, requiring repeated insertion of the LMA. The authors describe the management of this problem with the use of a tongue suture and anterior traction in the postoperative period in a resource-limited setting.
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Case Reports
Sphenopalatine Ganglion Block to Treat Shoulder Tip Pain After Thoracic Surgery: Report of 2 Cases.
Shoulder tip pain may occur after thoracic surgical procedures. The pain is caused by diaphragmatic irritation and is referred to the shoulder. Shoulder tip pain is often resistant to treatment with conventional analgesics. ⋯ We report here the first use of this block to treat shoulder tip pain in 2 thoracic surgical patients. In both patients, the block produced rapid and sustained relief of the shoulder tip pain. We suggest that sphenopalatine ganglion block be considered to treat postoperative shoulder tip pain after thoracic surgical procedures.