A & A case reports
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Review Case Reports
Perioperative Management for Abdominal Surgery in Bilateral Diaphragmatic Paralysis: A Case Report and Literature Review.
The optimal approach to postoperative analgesia in patients with bilateral diaphragmatic paralysis undergoing abdominal surgery remains unclear. We report a 69-year-old woman with bilateral diaphragmatic paralysis who underwent a laparoscopic hernia repair and an open laparotomy for reversal of a Hartmann procedure under general anesthesia. ⋯ The patient's trachea was successfully extubated at the end of both surgical procedures. Epidural analgesia was associated with better pain control and shorter intensive care unit stay.
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Review Case Reports
Hyperleukocytosis Complicated by Intracerebral Hemorrhage and Spurious Hypoxemia: A Case Report and Literature Review.
We present the management of a 15-year-old girl with acute myeloid leukemia who presented with massive hyperleukocytosis and neurological deficit due to intracerebral hemorrhage. Surgical intervention was considered but ultimately not undertaken because of the presence of massive hyperleukocytosis, thrombocytopenia, hypokalemia, and considerable discrepancy between the oxygen saturation values determined mechanically and by peripheral oximetry. Aggressive treatment of the hyperleukocytosis was immediately started, which improved the patient's overall condition and rendered surgical intervention unnecessary. This report shows that immediate treatment of massive hyperleukocytosis and critical interpretation of laboratory results in patients with hyperleukocytosis are warranted.
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Review Case Reports
Resuscitative Endovascular Balloon Occlusion of the Aorta and the Anesthesiologist: A Case Report and Literature Review.
The most common preventable cause of death after trauma is exsanguination due to uncontrolled hemorrhage. Traditionally, anterolateral emergency department thoracotomy is used for temporary control of noncompressible torso hemorrhage and to increase preload after trauma. ⋯ It is therefore imperative for the anesthesiologist to understand physiologic implications during resuscitative endovascular aortic occlusion and after balloon deflation. We report a case of a patient with significant pelvic and lower-extremity trauma who required acute resuscitative endovascular balloon occlusion of the aorta deployment, aggressive resuscitation, and extensive intraoperative hemorrhage control.
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Review Case Reports
Gas Embolism During Hysteroscopic Surgery?: Three Cases and a Literature Review.
During a period of 1 month, 3 episodes of probable or actual venous air embolism occurred during hysteroscopic surgery. All patients developed the same symptoms of ventilatory and hemodynamic decompensation, beginning with a reduction in end-tidal carbon dioxide, arterial desaturation, and cyanosis on the upper trunk, and rapidly progressed to hypotension and 2 cardiac arrests. While entrainment of some air is common during hysteroscopy, life-threatening embolism is a rare but serious complication for which an anesthetist needs to be vigilant and prepared. If even a small drop in end-tidal carbon dioxide occurs, venous air embolism should be suspected and the operation should be discontinued.
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Review Case Reports
Mechanical Support With Impella During Malignant Arrhythmia Ablation: A Case Report on the Growing Trend in the Electrophysiology Laboratory.
Congenitally corrected transposition of the great arteries is a rare form of congenital heart disease in which the persistence of the right ventricle as the systemic ventricle leads to heart failure, tricuspid valve insufficiency, and arrhythmia. Supraventricular arrhythmias are especially common in these patients. We discuss the anesthetic management of a 33-year-old patient with congenitally corrected transposition of the great arteries who required a ventricular assist device to maintain cardiac output during ablation of supraventricular tachyarrythmia. A witnessed pulseless cardiac arrest and resuscitation during a previous episode of supraventricular tachycardia prompted the elective insertion of the Impella catheter after induction of anesthesia for the ablation procedure.