A&A practice
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We report persistent postoperative paraplegia on recovery from anesthesia after emergent exploratory laparotomy for large bowel obstruction in a cachectic patient with an abdominal aortic aneurysm. Postoperative cervical, thoracic, and lumbar spine magnetic resonance imaging revealed only cervical spinal stenosis. We hypothesize that intraoperative embolization possibly caused by manipulation of an atherosclerotic aorta, and a brief episode of intraoperative hypotension resulted in spinal cord ischemia. This report highlights the importance of maintaining intraoperative hemodynamic stability and careful handling of the abdominal aorta, especially in underweight patients with an abdominal aortic aneurysm.
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A 62-year-old male patient suddenly developed severe dyspnea due to bilateral vocal cord paralysis (VCP) 4 days after an abdominal surgery. Emergent tracheostomy effectively improved the patient's respiratory status. The present case report emphasizes that bilateral VCP could occur even several days after an abdominal surgery in patients with multiple risk factors, such as hypertension, diabetes mellitus, an older age, male sex, and an upper abdominal surgery. Even if the patient does not present with hoarseness, bilateral VCP should not be ruled out, because a slight phonetic change can be the only symptom of early-stage bilateral VCP.
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Sternotomy pain is a common complication after cardiac surgery. We present a 77-year-old patient with severe acute sternal pain after coronary artery bypass graft surgery who was successfully treated with a novel peripheral regional anesthetic technique, the pecto-intercostal fascial block. This interfascial plane block may represent an effective regional anesthetic component of a multimodal analgesic strategy for cardiac surgery patients who suffer from significant pain after a median sternotomy and are typically anticoagulated.
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Atrioventricular groove separation is a rare complication of mitral valve surgery. We present a case occurring during aortic valve surgery that was detected by the anesthesiologist using transesophageal echocardiography (TEE). ⋯ This blood flow expanded into the aorto-mitral curtain during systole, consistent with atrioventricular groove separation. We review the pathophysiology behind groove separations and discuss diagnosis of these rare conditions using TEE.