A & A case reports
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Loeys-Dietz syndrome (LDS) is a rare connective tissue disorder predisposing to aortic and arterial aneurysms. Presentations are classified into subtypes based on gene mutations. ⋯ We report successful management of an elective cesarean delivery in a 16-year-old patient with LDS type IV using epidural anesthesia. Perioperative considerations and multidisciplinary management specific to taking care of parturients with LDS are discussed.
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Waldenström's macroglobulinemia (WM) manifests as hyperviscosity syndrome. Cryoglobulinemia, which may increase blood viscosity or induce thrombosis in association with decreased body temperature, can occur in combination with WM. We describe the management of an 82-year-old woman with WM, hyperviscosity syndrome, and cryoglobulinemia who required open aortic valve replacement. Decreased body temperature in this patient was prevented during cardiopulmonary bypass by using a forced air warming system and normothermic cardioplegia with continuous warm blood cardioplegia perfusion.
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We describe the case of a 41-year-old woman with metastatic cervical cancer and a large mass eroding into the pelvis and left lumbosacral plexus. The patient had intractable left lower extremity pain refractory to standard therapies, and she elected to undergo intrathecal neurolysis. ⋯ During both procedures, we used a tilting radiolucent orthopedic fracture table to maintain strict left lateral-supine positioning. A tilting orthopedic fracture table may be a valuable adjunct to ensure positional stability during intrathecal neurolysis.
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Case Reports
Essential Thrombocytosis and Labor Epidural Placement While on Aspirin: Assessing Hemorrhagic Risks: A Case Report.
Essential thrombocytosis (ET) is a rare disease with known thrombotic and bleeding complications. We encountered a patient with a diagnosis of longstanding Janus kinase-2 gene-negative ET on aspirin therapy presenting for labor epidural. ⋯ The relevant issues of ET for anesthesia management with labor epidurals are discussed. Unique, relevant, and unexpected findings from the platelet function testing are presented.
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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.