A & A case reports
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Thresholds for platelet counts in patients at risk for bleeding are often used before surgery. We present a case report of a 13-year-old female with chronic idiopathic thrombocytopenia purpura for dental extraction with a platelet count of 4 × 10 L. Usually, therapies including platelet infusions, IV immunoglobulin, or corticosteroids would be used to increase platelet numbers. In this patient, rather than using any of these prophylactic therapies preoperatively, we used a "watchful waiting" strategy with a multidisciplinary team, the use of tranexamic acid and the aforementioned therapies available only as "rescue" agents.
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An 8-year-old girl with McCune-Albright syndrome presented for resection of a very large fibrous dysplasia mass of the face with significant distortion of the airway anatomy. She had significant obstructive sleep apnea with daytime somnolence and hemoglobin oxygen desaturations while breathing room air preoperatively. We were able to successfully manage her airway by providing IV sedation, topical anesthesia of the airway, and oral fiberoptic intubation in close collaboration with our otorhinolaryngology colleagues.
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A 19-year-old girl suffered an unexpected gasoline-associated chemical burn injury that may have been intensified by a warming device and tissue pressure in the operating room. Anesthesiologists should be aware that serious skin injury may result from combination of cutaneous exposure to hydrocarbons, especially when warming devices are simultaneously used.
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Sequential bilateral lung separation and selective lung collapse can be accomplished with either a double-lumen tube, a single bronchial blocker (BB) that must be repositioned during the operation, or by using 2 BBs, 1 placed in each main bronchus. We provided sequential bilateral lung collapse using a single BB without the need to reposition during surgery.
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Occurrence of severe hypotension after indocyanine green injection during the intraoperative period.
Indocyanine green (ICG) is generally considered to be safe for IV administration and has a very low incidence of complications. We report 2 cases of severe hypotension immediately after low dose administration of IV ICG. ⋯ Anesthesiologists and surgeons are increasingly likely to encounter or request the intraoperative administration of ICG, and they need to be aware of this potential for an adverse reaction, particularly with the repeated doses. Anesthesia and other intraoperative conditions may mask the typically mild adverse reactions usually associated with ICG.