A & A case reports
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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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We report 5 patients who underwent ultrasound-guided superior laryngeal nerve block before awake intubation and general anesthesia. We used a 8- to 15-MHz hockey stick-shaped ultrasound transducer (HST15-8/20 linear probe, Ultrasonix) to visualize the superior laryngeal nerve. ⋯ All 5 patients tolerated subsequent awake fiberoptic intubation with either minimal or no sedation. Sonographically guided superior laryngeal nerve block may be useful in patients where identification of landmarks in the neck is difficult as a result of patient anatomy.
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Case Reports
Paradoxical air embolus during endoscopic retrograde cholangiopancreatography: an uncommon fatal complication.
Air embolism during endoscopic retrograde cholangiopancreatography is a rare but potentially fatal complication. A 66-year-old man underwent endoscopic retrograde cholangiopancreatography and remained stable until the end of the procedure, when he was found to have mottling on his right side and became hypoxic and unresponsive. ⋯ Mortality resulted from significant cardiac and cerebral ischemia. The literature suggests that capnography is helpful in early diagnosis of air embolus, but it could not be used in this case because the patient's trachea was not intubated.
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Case Reports
Massive pulmonary embolism in pregnancy treated with catheter-directed tissue plasminogen activator.
Pulmonary embolism is a leading cause of maternal death in the United States, contributing to the death of approximately 2 women per 100,000 live births each year. Thrombosis during pregnancy traditionally is treated conservatively with unfractionated heparin or low-molecular-weight heparin; however, cardiovascular collapse associated with a large pulmonary embolus may require immediate aggressive intervention to save the mother and fetus. We report the use of catheter infusion thrombolysis in the successful management of a third-trimester pregnant patient with a hemodynamically significant saddle pulmonary embolus.