A & A case reports
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Ventricular assist devices (VADs) provide mechanical circulatory support for patients with advanced heart failure. Patients with VADs are presenting for noncardiac surgery with increasing frequency. Understanding anesthetic management of patients with VADs is timely and necessary for perioperative physicians. We present 2 patients supported by left VADs who required intraoperative prone positioning, and how transesophageal echocardiography and VAD variables can be used to guide management.
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Lipodystrophies are acquired or inherited disorders characterized in part by the selective loss of adipose tissue and hypertriglyceridemia. The present case report of 2 sevoflurane anesthetics given to a child with such a disorder, before and after correction of severe hypertriglyceridemia, illustrates the considerable effects of increased serum lipids and decreased fat stores on the pharmacokinetics of sevoflurane.
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Systemic air embolism is a complication after IV injection of air bubbles adhering to IV tubing, 3-way injection ports, and residual air in drug-filled syringes. Paradoxical air embolism across an intracardiac septal defect is a well-known complication, but paradoxical air embolism to the left coronary artery is a rare condition. We report the case of a 50-year-old woman scheduled for elective device closure of an atrial septal defect in whom coronary air embolism to the left anterior descending artery occurred after anesthetic induction.
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Before cannulation of the internal jugular vein (IJV) in 4 pediatric patients, we obtained in-plane and out-of-plane ultrasound images of the vertebral artery (VA). In 2 of 4 patients, abnormalities were identified and best imaged in the in-plane view. ⋯ In another patient, the in-plane image of both the IJV and the VA clearly showed a narrowed IJV. In some cases, the relationship between the VA and IJV may be more clearly understood with in-plane imaging.