A & A case reports
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A 44-year-old woman presented for sentinel node biopsy and segmental mastectomy. After anesthetic induction, a laryngeal mask airway was placed, and ventilation was satisfactory. Three minutes after isosulfan blue dye injection, ventilation became difficult. ⋯ Twenty minutes later, she became hypotensive and unresponsive to phenylephrine, ephedrine, and vasopressin. With erythema and swelling in her arm and chest, low-dose epinephrine was titrated until her mean arterial blood pressure stabilized. Serum tryptase was increased to 27.2 μg/L (normal 0.4-10.9 μg/L).
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A 34-year-old parturient developed third-degree atrioventricular block, in the setting of hypotension, after spinal anesthesia for cesarean delivery. The arrhythmia fully resolved with anticholinergic and sympathomimetic drugs. Considering the increasing maternal morbidity and potential risk of maternal cardiac arrest, this critical state is reviewed, and a treatment algorithm is suggested.
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The mucopolysaccharidoses are a group of lysosomal storage diseases with many skeletal and airway features that pose a challenge to anesthetists. We present the anesthetic management of a woman with mucopolysaccharidosis type VI undergoing cervical spine surgery and review the perioperative issues that may arise with this disease.
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Extracorporeal life support may be used in patients with refractory cardiogenic shock. The femoral venoarterial route can be used for implanting cannulae in patients who are hemodynamically unstable. ⋯ The procedure was performed using 40 mL of a 50:50 mixture of 0.5% levobupivacaine and 2% lidocaine (30 mL for transversus abdominis plane and 10 mL for genitofemoral block) associated with low-dose remifentanil infusion during spontaneous breathing. A left ventricular assist device was successfully implanted 4 days later.
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Ethanol sclerotherapy is a first-line treatment for low-flow vascular malformations. Although many complications of ethanol sclerotherapy have been described in the literature, bronchospasm is uncommon. We present a case of a patient in whom bronchospasm was precipitated by injection of ethanol during percutaneous sclerotherapy for craniofacial venous malformations that occurred during general anesthesia. The evidence for ethanol-induced bronchospasm is discussed.