A & A case reports
-
Congenital rubella syndrome (CRS) is caused by rubella virus infection of the pregnant mother leading to teratogenic effects on the fetus. Although rare in the developed world, manifestations reach far into adulthood and underscore the importance of careful evaluation before surgery. We present a case of an adult with CRS in whom unexpected prolonged postoperative respiratory depression occurred. Perioperative workup of CRS and investigations pertaining to the patient's respiratory insufficiency are discussed.
-
A 4-year-old female developed hypotension, tachycardia, hypoxemia, and diffuse erythema after induction of anesthesia with ketamine, fentanyl, and cisatracurium. Treatment consisted of repeated doses of epinephrine, diphenhydramine, corticosteroids, and IV fluids. ⋯ She had experienced hypotension on the ninth exposure to cisatracurium but the decrease in arterial blood pressure was attributed to propofol. On the tenth exposure to cisatracurium, the patient developed evidence of anaphylactic shock that led to the diagnosis.
-
We report the case of a man with a massive pulmonary embolism, which lead to cardiac arrest. After ruptured aneurysm clipping, he was successfully treated by rescue thrombolysis administered as compassionate treatment despite the risk of cerebral bleeding. The patient was discharged from the intensive care unit; his initial neurological, cardiac, and pulmonary conditions restored. In case of life-threatening pulmonary embolism, the risk-benefit ratio of thrombolysis therapy should be systematically evaluated and the decision adapted to each patient.
-
Failure of a double-lumen endotracheal tube (DLT) to isolate the lung during thoracic surgery can have significant consequences. In this report, we examine an approach for rescuing a malpositioned DLT. ⋯ A 7-Fr Arndt bronchial blocker was positioned through the tracheal lumen of the DLT to obtain 1-lung ventilation. This technique can be used to rescue a malfunctioning DLT without the need for extubating and reintubating the trachea.
-
A 61-year-old female ex-smoker presented with a suspicious right lower lobe mass after previously undergoing a left pneumonectomy. Due to the peripheral nature of the lung lesion, a right thoracoscopic wedge resection was proposed by the surgical team. ⋯ The trachea was extubated in the operating room, and the patient recovered uneventfully from the procedure. This case demonstrates the feasibility of limited thoracoscopic lung resections postpneumonectomy with the use of high-frequency jet ventilation.