A & A case reports
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Monitoring of cerebral perfusion by near-infrared spectroscopy estimates regional cerebral oxygen saturation (rSO2). We present a case in which, before clamping the left carotid artery during an endarterectomy, the right and left rSO2 measurements were 72% and 74%, respectively. Within 15 seconds of clamping the external carotid artery, the left rSO2 decreased by 8%, yielding right and left rSO2 measurements of 70% and 66%, respectively. ⋯ The internal carotid artery was clamped 1 minute later, whereas the external carotid remained clamped. No electroencephalogram changes were observed. The rSO2 measurements demonstrate that the value of this cerebral oximetry is not determined solely from internal carotid blood flow and can be significantly affected by the external carotid.
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As the population ages, geriatric patients with preexisting cardiac disease are presenting for noncardiac surgery in escalating numbers. The decision to proceed with surgery in such patients often is multifactorial. ⋯ However, both patients died postoperatively because of their comorbidities. Although published guidelines are sparse, we hope this report will increase awareness and discussion about caring for geriatric patients with severe aortic stenosis.
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Accidental inhalation of powder is a potential problem for infants. The clinical effects of inhaling powder depend on the powder contents, degree of aspiration, and the child's underlying systemic response. We present a case of accidental inhalation of rice starch powder in a 17-month-old girl, which led to severe acute respiratory distress syndrome responsive to conventional treatment, ultimately requiring venous-venous extracorporeal membrane oxygenation.
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Sudden visual loss after general anesthesia is a rare and serious complication. Unilateral visual loss can be caused by an increase in pressure in the preretinal veins with subsequent rupture and hematoma formation. Our patient most likely experienced an increase in venous pressure as a consequence of temporarily increased intrapulmonary pressures during a sustained Valsalva maneuver shortly after tracheal intubation. Although surgical correction is available, in almost all cases, no specific therapy is required because the problem completely regresses spontaneously.
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The number of patients with noncardiac implantable electronic devices is increasing, and the absence of perioperative management standards, guidelines, practice parameters, or expert consensus statements presents clinical challenges. A 69-year-old woman presented for latissimus dorsi breast reconstruction. The patient had previously undergone implantation of a spinal cord stimulator, a gastric pacemaker, a sacral nerve stimulator, and an intrathecal morphine pump. ⋯ Bipolar cautery was used intraoperatively. Postoperatively, all devices were interrogated to ensure appropriate functioning before home discharge. Perioperative goals include complete preoperative radiologic documentation of device component location, minimizing electromagnetic interference, and avoiding mechanical damage to implanted device components.