A & A case reports
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Hypotension or bradycardia or both related to intracranial hypotension after craniotomy has been reported in the literature. However, such reports are uncommon with thoracic epidural drains. We describe a case in which application of high negative pressure suction to a thoracic epidural drain caused a sudden decrease in arterial blood pressure.
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Patients presenting with alcohol withdrawal syndrome have an increased risk of perioperative events related to hemodynamic and respiratory instability. We present the case of a 49-year-old achondroplastic dwarf in alcohol withdrawal with cervical spinal cord injury and aortic dissection requiring emergency surgery. Due to conflicting perioperative management goals, a decision was made to delay surgery until the patient became clinically stable. Additional options might have been explored and resulted in better outcome.
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We present 2 cases of patients with septic shock and discuss changes in B-type natriuretic peptide (BNP) levels. While previous increases in BNP in septic shock were attributed to the accompanying myocardial depression, recent work claims that high levels of BNP in sepsis are related to an alteration in the BNP clearance pathway. We postulate from these cases that increased BNP should not automatically be associated with cardiac dysfunction and may assist in an early, difficult diagnosis of septic shock.
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Video-assisted thoracoscopic surgery has become a common procedure in pediatric surgery. We present a case of accidental intraoperative bronchopleural fistula during a video-assisted thoracoscopic surgery procedure, which was first identified by the anesthesia team. We discuss differential diagnoses including the role of end-tidal carbon dioxide monitoring as an aid to prompt diagnosis.
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We present a patient with myasthenia gravis in whom sugammadex failed to restore the train-of-four ratio (TOFR) sufficiently. When the patient's TOFR count had recovered to 2, we administered 2 mg/kg of sugammadex. ⋯ We then administered 30 μg/kg of neostigmine which restored the TOFR to more than the preoperative value. We speculate that exacerbation of myasthenia symptoms during surgery interfered with recovery of TOFR after sugammadex administration.