A & A case reports
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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.
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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.
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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.
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I report the occurrence of left arytenoid dislocation in 2 patients undergoing laparoscopic surgical procedures formerly used only for weight loss and that are now being used for treatment of diabetes. After uncomplicated tracheal intubation, a calibrating orogastric tube was inserted into the esophagus blindly and without difficulty. ⋯ I suspect that the insertion of the calibrating orogastric tube in these nonobese patients may have led to the development of this rare complication. Recognition of its occurrence and subsequent treatment are important to preventing long-term consequences of arytenoid dislocation.