A & A case reports
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Progressive encephalomyelitis with rigidity and myoclonus (PERM) is a rare autoimmune neurological condition. Antibodies targeting glycine receptors (GlyR) have been implicated in PERM. ⋯ We describe a case of general anesthesia in a patient with PERM and GlyR antibodies. This patient did not demonstrate a clinically significant alteration in the behavioral effects of anesthesia using induction of anesthesia with sevoflurane and maintenance of anesthesia using sevoflurane and nitrous oxide.
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Ventricular assist devices (VADs) provide mechanical circulatory support for patients with advanced heart failure. Patients with VADs are presenting for noncardiac surgery with increasing frequency. Understanding anesthetic management of patients with VADs is timely and necessary for perioperative physicians. We present 2 patients supported by left VADs who required intraoperative prone positioning, and how transesophageal echocardiography and VAD variables can be used to guide management.
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Lipodystrophies are acquired or inherited disorders characterized in part by the selective loss of adipose tissue and hypertriglyceridemia. The present case report of 2 sevoflurane anesthetics given to a child with such a disorder, before and after correction of severe hypertriglyceridemia, illustrates the considerable effects of increased serum lipids and decreased fat stores on the pharmacokinetics of sevoflurane.
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Systemic air embolism is a complication after IV injection of air bubbles adhering to IV tubing, 3-way injection ports, and residual air in drug-filled syringes. Paradoxical air embolism across an intracardiac septal defect is a well-known complication, but paradoxical air embolism to the left coronary artery is a rare condition. We report the case of a 50-year-old woman scheduled for elective device closure of an atrial septal defect in whom coronary air embolism to the left anterior descending artery occurred after anesthetic induction.