A & A case reports
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This article describes 2 patients with severe acute right ventricular failure causing circulatory shock. Portal vein pulsatility assessed by bedside ultrasonography suggested clinically relevant venous congestion. Management included cardiac preload reduction and combined inhalation of milrinone and epoprostenol to reduce right ventricular afterload. Portal vein ultrasonography may be useful in assessing right ventricular function in the acutely ill patient.
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Not all postpartum headaches are caused by dural puncture, and it is possible for postpartum patients to have >1 cause for headache. After neuraxial block with an incidental large-gauge dural puncture, our patient developed a severe, classic postdural puncture headache which initially responded to an epidural blood patch. ⋯ Computerized tomography and magnetic resonance imaging revealed an enlarged pituitary gland with a possible hemorrhagic focus; all endocrine parameters were normal. The patient was ultimately diagnosed with lymphocytic adenohypophysitis, an autoimmune inflammation of the anterior pituitary gland.
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We report the case of 2 pediatric patients with coexisting diagnoses of malignant hyperthermia susceptibility and mitochondrial disease in 2 different surgical settings. Due to the rare occurrence of each disorder, and even more so together, we reviewed evidence-based anesthetic concerns and described our perioperative management, with the goal of aiding future practitioners in safely caring for these patients. Consent was obtained for both patients, as well as IRB approval before publication.
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A 28-year-old man presented with a penetrating injury by a nail gun to the head. Imaging revealed a nail abutting the superior sagittal sinus without active extravasation. ⋯ In the operating room, the nail was removed under general anesthesia, with blood products and equipment for craniotomy readily available, and imaging modalities reserved for immediate use. This case highlights the importance of a multidisciplinary approach to challenging penetrating head injuries and the crucial role anesthesiologists have as leaders in perioperative care.