A & A case reports
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Case Reports
Superimposed cocaine-induced rhabdomyolysis in a patient with aortic dissection rhabdomyolysis.
A 52-year-old man presented with acute, sharp chest pain radiating to the back and abdomen after using cocaine 18 hours previously. Computed tomographic angiography revealed a type B aortic dissection that extended to the iliac arteries. ⋯ The combination of aortic dissection and creatine kinase toxicity was extensive enough to cause permanent renal failure and paraplegia below T6. The severity of the patient's symptoms was attributed to concomitant cocaine-induced rhabdomyolysis and aortic dissection rhabdomyolysis.
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Review Case Reports
General anesthesia for adults with mitochondrial myopathy.
We report the case of a 59-year-old woman with mitochondrial myopathy who underwent elective laparoscopic cholecystectomy and hemorrhoidectomy, and we review the literature discussing general anesthesia for adults with mitochondrial myopathy. Our management technique avoids neuromuscular-blocking drugs and uses a modified awake intubation method not previously described in such patients. We hope to improve patient safety by discussing evidence-based anesthetic concerns and complications specific to these uncommon patients and aid practitioners in devising a suitable anesthetic plan.
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Case Reports
Stellate ganglion local anesthetic blockade and neurolysis for the treatment of refractory ventricular fibrillation.
Electrical storm (ES) is a syndrome characterized by recurrent ventricular fibrillation or tachycardia. It is a major clinical challenge and is often unresponsive to conventional drug therapy; instead, its treatment requires multiple attempts at electrical defibrillation. ⋯ We report a case of ES treated safely and effectively with pharmacologic sympathectomy involving diagnostic continuous stellate ganglion blockade with local anesthetic followed by therapeutic neurolysis. This technique reduced ES in a patient for whom conservative medical and interventional procedures were ineffective.
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Case Reports
Polyethylene glycols (PEG) and related structures: overlooked allergens in the perioperative setting.
We describe hypersensitivity to polyethylene glycols (PEGs), with cross-reactivity to a structural analog, polysorbate 80, in a 69-year-old patient with perioperative anaphylaxis and subsequent, severe anaphylactic reactions to unrelated medical products. PEGs and PEG analogs are prevalent in the perioperative setting, contained in a wide range of products seldom suspected of causing hypersensitivity reactions and thus rarely documented in surgical/anesthetic records. We suggest routine testing for PEGs after perioperative anaphylaxis because exposure to these polymers often is significant. Comprehensive brand name documentation on the anesthetic chart of all product exposures is central to identifying the responsible allergen.
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Retrograde type A aortic dissection that arises immediately after open replacement of the thoracoabdominal aorta is a rare and potentially lethal complication that has only been reported twice previously. A 74-year-old man with a history of expanding Crawford type I thoracoabdominal aortic aneurysm presented for open surgical repair. ⋯ Subsequently, emergent aortic arch repair was performed under deep hypothermic circulatory arrest. Early diagnosis with transesophageal echocardiography and optimal cerebral protection were instrumental in the successful outcome of this repair.