Journal of clinical anesthesia
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Angioedema is a potentially life-threatening condition that may present at any point in the perioperative care of patients. It requires prompt recognition and diagnosis; the primary concern during acute attacks is airway management. The pathophysiology, various causes of angioedema, and treatment strategies according to underlying etiology are presented.
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Bilateral total knee replacement is becoming one of the more commonly performed orthopedic procedures for patients with advanced arthritis of both knees. The surgeon may decide to operate on both knees simultaneously, sequentially, or in a staged manner. The safety of this procedure is still debated due to wide variation in the studies and their endpoints. Although there are advantages with bilateral procedures such as reduced cost and improved rehabilitation, there is definite evidence of increased cardiopulmonary, thromboembolic, neurological, bleeding, and transfusion complications with bilateral knee replacement versus unilateral knee replacement, particularly in elderly patients with comorbidities.
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Neural blockade of the scalp may be used as an adjunct to general anesthesia or serve as the principal anesthetic for both intracranial and extracranial procedures. Effective scalp blockade typically requires anesthetizing multiple peripheral nerves; blockade of one or more of these is often used to diagnose and treat conditions such as chronic headache. ⋯ The vascularity of the scalp, proximity of arteries supplying the cerebral circulation, use of large volumes of local anesthetic, and presence of intracranial devices or bony defects require attention. The impact of perioperative scalp blockade on acute and chronic pain may offer insight into the benefits of perioperative neural blockade generally.
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Postoperative airway compromise due to laryngopharyngeal edema is a potentially serious adverse event associated with anterior cervical spine surgery. The reported incidence of this complication has varied from 1.2% to 6.1%, with a higher incidence following multi-level surgery. The relevant literature on airway compromise following anterior cervical spine surgery is reviewed.
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Review Case Reports
Severe hypothyroidism presenting as myxedema coma in the postoperative period in a patient taking sunitinib: case report and review of literature.
The case of a 62-year-old Caucasian woman who underwent urgent hip hemiarthroplasty for repair of a pathological fracture is reported. The patient's medical history was significant for renal cell carcinoma, cerebellar metastases, and sunitinib-induced hypothyroidism. Her intraoperative course was complicated by profound hypothermia, bradycardia, augmentation of neuromuscular blockade, delayed emergence, failure of postoperative extubation, and need for mechanical ventilation. The intensive care course was significant for hypothermia requiring forced-air warming, treatment with intravenous thyroxine (T4), and hemodynamic supportive care.