Journal of clinical anesthesia
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Cardiac arrest in the perioperative period is associated with significant morbidity and mortality. Novel resuscitation devices may afford patients improved survival and limit neurologic injury. We report a case of cardiac arrest in the postanesthesia care unit that required an extensive period of cardiopulmonary resuscitation assisted by the ResQPOD impedance threshold device to optimize coronary perfusion and a LUCAS chest compression system to maintain optimal cardiopulmonary resuscitation while transporting the patient to the cardiac catheterization laboratory. Furthermore, after stabilization for an occluded left anterior descending artery with stent placement, an institutional hypothermia protocol was initiated using Thermogard XP Temperature Management system for 24 hours.
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Hereditary angioedema with normal C1-esterase inhibitor (HAE-nC1INH) perioperative is a rare condition which could have potential disastrous ramifications for the anesthesiologist in the perioperative period. However, there is limited evidence and/or guidelines on the optimal way to manage these patients. We present the case of a patient with HAE-nC1INH who was successfully managed in the perioperative period with plasma derived C1-esterase inhibitor (pdC1INH). ⋯ Both pdC1INH and tranexamic acid were given preoperatively. The patient underwent surgery with no complications. A multidisciplinary team of clinical immunologists, transfusion medicine specialists, and anesthesiologists facilitated the successful perioperative management of a patient with HAE-nC1INH; pdC1INH may a suitable prophylactic perioperative therapy for this rare patient population.
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The aim of this study was to compare the effectiveness of epsilon-aminocaproic acid (εACA) and tranexamic acid (TXA) in contemporary clinical practice during a national medication shortage. ⋯ Substitution of εACA with TXA during a national medication shortage produced equivalent postoperative bleeding and red cell transfusions, although patients receiving εACA were more likely to require supplemental hemostatic agents.
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Comparative Study
Does dexmedetomidine cause less airway collapse than propofol when used for deep sedation?
The risk of airway collapse in patients undergoing deep sedation is a major concern. In this study, we compared the airway patency of deep sedation provided by propofol with the airway patency of deep sedation provided by dexmedetomidine in magnetic resonance imaging (MRI) procedures. This comparison was done using MRI static and dynamic images and comparing these images to baseline after sevoflurane induction. ⋯ In deep sedation, which is commonly associated with a loss of airway tone, it may not matter which of these intravenous study agents are used. Intravenous sedation with propofol or dexmedetomidine appears to produce the same effect on the pediatric airway.
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Case Reports
Undiagnosed pulmonary sequestration results in an unexplained hemorrhagic shock in thoracoscopic pulmonary lobectomy.
We report the first case of pulmonary sequestration which was not detected in the preoperative evaluation, resulting in a life-threatening hemorrhagic shock rapidly during the procedure of thoracoscopic pulmonary lobectomy. The anesthesiologists could not figure out the reason for the hemorrhagic shock in the surgery until an emergent laparotomy was performed. The aim of presenting this clinical case is to highlight the vigilance for undiagnosed pulmonary sequestration which lacks any specific clinical feature but has the potential to become an anesthetic disaster.