A & A case reports
-
Risk factors for intraoperative immediate-type hypersensitivity reactions may require allergological evaluation. We report the case of a hairdresser with a positive history of penicillin hypersensitivity and anaphylactic shock during previous general anesthesia, whose in vivo and in vitro allergy tests were positive for neuromuscular blocking agents, opioids, and midazolam. Immediate-type hypersensitivity reactions to antibiotics and professional exposure to hairdressing products might induce simultaneous cross-sensitization to multiple drugs that are commonly used during general anesthesia.
-
Case Reports
Chest Pain During Cesarean Delivery in Relation to Anomalous Right Coronary Artery: A Case Report.
Chest pain during labor can have many etiologies, one of which is myocardial ischemia. We report a 38-year-old woman with American Society of Anesthesiology physical status I scheduled for elective cesarean delivery who experienced chest pain and electrocardiographic signs of myocardial ischemia immediately after carbetocin administration. ⋯ This was considered the likely cause of the patient's chest pain. The patient gave written permission for the authors to publish this report.
-
Acquired tracheoesophageal fistula is a rare and devastating complication of lung cancer. The diagnosis is typically confirmed on barium esophagram. We report a case of a patient with lung cancer status after palliative chemoradiotherapy and esophageal stenting for malignant stenosis who presented with signs and symptoms suggestive of tracheoesophageal fistula; however, no evidence of fistula was found on barium esophagram. During subsequent esophagogastroduodenoscopy, the presence of a fistula was verified by capnography, given extreme elevations in end-tidal CO2 concentrations during endoscopic CO2 insufflation.
-
Case Reports
Elective Venovenous Extracorporeal Membrane Oxygenation for Resection of Endotracheal Tumor: A Case Report.
We present a case in which we electively used venovenous extracorporeal membrane oxygenation (VV-ECMO) to facilitate safe resection of a nearly obstructing airway tumor near the carina in a 37-year-old male. The patient was brought to the operating room and underwent bifemoral cannulation for VV-ECMO under light sedation while maintaining spontaneous ventilation. After VV-ECMO was initiated, general anesthesia was induced, and the tumor was resected via rigid bronchoscopy. After resection, the patient was intubated, weaned from ECMO, decannulated, awoken, extubated, and taken to the postanesthesia care unit for recovery.
-
In a patient undergoing thoracoscopic esophagectomy and concomitant wedge resection, an iatrogenic lesion in the left main bronchus was observed following deflation of the right lung. Because the bronchial cuff of the double-lumen tube was visible through the lesion, repair was only possible after deflation of the bulging cuff. ⋯ This challenging situation was resolved using the Ventrain device to oxygenate the patient through a small-bore catheter placed through the lumen beyond the bronchial defect. With the use of this technique, oxygenation was maintained at an acceptable level during repair.