Journal of clinical anesthesia
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Case Reports
Spinal epidural hematoma occurrence in the absence of known risk factors: a case series.
Spinal epidural hematoma in the absence of coagulopathy or anticoagulation therapy is an extremely rare occurrence, with a reported incidence of less than 1 in 1 million. We present seven cases of documented epidural hematoma in the absence of coagulopathy or anticoagulation therapy to alert the clinician to consider spinal or epidural hematoma when suspicious signs and symptoms are present after neuraxial block in the absence of coagulopathy or anticoagulation therapy. The need for immediate diagnosis and therapy is emphasized as the only potential for meaningful recovery.
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A 36-year-old, 204-kg parturient with a past medical history of Factor V Leiden requiring enoxaparin therapy developed a postdural puncture headache. With careful coordination of her enoxaparin dosing, an epidural blood patch was successfully performed. Performance of a blood patch in patients taking enoxaparin involves the withholding of the medication for a specific period.
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Case Reports
Spinal epidural hematoma following central neuraxial blockade and subcutaneous enoxaparin: a case report.
An elderly patient developed a spinal epidural hematoma 3 days after lumbar puncture resulting in paraplegia. Concurrent administration of enoxaparin, aspirin, ketorolac, and a traumatic tap were implicated in causation.
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Randomized Controlled Trial Clinical Trial
Does sealing endotracheal tube cuff pressure diminish the frequency of postoperative laryngotracheal complaints after nitrous oxide anesthesia?
To study endotracheal tube (ETT) cuff pressures during nitrous oxide (N2O) anesthesia when the cuffs are inflated with air to achieve sealing pressure, and to evaluate the frequency of postoperative laryngotracheal complaints. ⋯ Minimum ETT sealing cuff pressure during N2O anesthesia did not prevent, but instead attenuated, the increase in cuff pressure and did not decrease postoperative laryngotracheal complaints.
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We describe a 67-year-old woman with cholangiocarcinoma who was scheduled for cholecystectomy, trisegmentectomy, bile duct resection, and regional lymphadenectomy. Her case was complicated by hyperlactatemia, sepsis, and multiorgan failure. The discussion reviews the possible causes of the hyperlactatemia and reviews measures that could be used to reduce this risk.