A & A case reports
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The tracheal tube (TT) connector needs to be firmly seated in both the TT and the breathing circuit to prevent disconnection during use. However, at times, the connector may loosen from its connection into the TT, increasing the likelihood of disconnection. We report a very simple yet useful technique to circumvent this problem.
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Case Reports
Contemporary perioperative management of adult familial dysautonomia (Riley-Day syndrome).
Familial dysautonomia (Riley-Day syndrome) is a rare multisystem disorder associated with an excess risk of perioperative morbidity and mortality. Because life expectancy is limited, few reports consider the perioperative management of familial dysautonomia in adults with advanced disease and end-organ dysfunction. Here, we report on the management of an adult patient with familial dysautonomia, highlighting recent developments in perioperative technology and pharmacology of special relevance to this challenging population.
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Case Reports
Airway Compromise and Perioperative Management of a Patient with Acquired Factor XIII Inhibitor.
Perioral hematomas can lead to acute airway compromise and can present significant challenges in both direct and indirect approaches to airway instrumentation. In patients with normal cell counts and routine coagulation tests, spontaneous hematomas are rare, but when encountered, they elicit a limited differential diagnosis that includes von Willebrand factor deficiency, platelet dysfunction, and the acquired factor XIII (FXIII) deficiency. Although spontaneous hematoma formation resulting from FXIII inhibition has been reported, we describe what may be the first reported case of FXIII inhibitor-related hematoma leading to acute airway compromise. Successful management of this patient required multidisciplinary cooperation among anesthesiologists, intensivists, otolaryngologists, and hematologists.
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Venous gas embolism is a complication of fibrin sealant application and is a well-described event during various modes of prostate resection. We describe the case of a nitrogen venous gas embolism during Greenlight laser photovaporization of the prostate during the application of fibrin sealant to the operative site for hemostasis. Fibrin sealant application by a compressed gas applicator is a cause of venous air embolism, and this case highlights the need to keep venous gas embolism in mind when compressed gas applicators are used.
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Case Reports
Positioning artifact causing retained foreign object appearance in a radiograph of a venous catheter.
In preparation for an abdominal tumor debulking procedure, a patient had a right internal jugular central venous catheter (CVC) inserted. A radiologist interpreted a postoperative chest radiograph as containing a 7-cm foreign body in the distal lumen of the CVC. ⋯ The manufacturer (Arrow®) states that the synthetic plug is part of standard CVC construction that may produce a radiopaque signal with specific patient positioning during radiography. This report is intended to raise awareness of the potential for this radiographic finding and prevent the unnecessary removal of clinically indicated CVCs.