A & A case reports
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A 43-year-old woman with a history of the Cushing syndrome secondary to adrenocortical carcinoma presented to the operating room for right adrenalectomy, hepatectomy, nephrectomy, and inferior vena cava (IVC) thrombectomy. Initial intraoperative transesophageal echocardiogram (TEE) confirmed the presence of an IVC tumor below the hepatic veins. ⋯ The remainder of the procedure finalized uneventfully. The case highlights the importance of TEE monitoring for noncardiac surgery with thrombotic involvement of the IVC.
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Case Reports
Needle Migration to the Heart: An Unusual Association of Hemodialysis and Cardiovascular Morbidity.
In this report, we present a unique complication of hemodialysis: the hemodialysis access needle was lost into an arteriovenous fistula. The event went unnoticed for several months. ⋯ Loss of the needle was likely unrecognized because of the use of a retracting safety cannula that conceals the needle within a sheath after removal. This case highlights a rare and potentially serious complication of hemodialysis access, demonstrates a possible hazard of retracting safety needles, and reviews the management of foreign bodies that have migrated into the heart.
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A 65-year-old man was admitted for acute coronary syndrome with depressed left ventricular function and moderate aortic regurgitation. He was managed with an intraaortic balloon pump for circulatory support before coronary artery bypass grafting and subsequently developed flash pulmonary edema with an associated rare finding of diastolic pulmonary venous flow reversal. In this report, we provide a review of intraaortic balloon pump use in current clinical practice and elaborate on the pathophysiology of an uncommon pulmonary venous flow pattern found in our patient.
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Effective multimodal analgesia and sedation reduce the postoperative morbidity and mortality associated with newborn bladder exstrophy repair. Epidural analgesia is safe and effective for major surgery in neonates and infants, reducing the need for muscle relaxants, opioids, and ventilator support postoperatively. ⋯ In this report, we describe the postoperative analgesic management of an infant undergoing bladder exstrophy repair using a directly placed tunneled epidural catheter with ropivacaine 0.1% infusion. Because of the prolonged infusion, we also monitored plasma ropivacaine levels to preclude systemic toxicity from local anesthetic overdose.
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Case Reports
Safety Concerns About an Epidural Blood Patch in a Patient with Extensive Epidural Fluid Accumulation.
We present a case of postdural puncture headache in a patient with extensive epidural fluid accumulation. An initial epidural blood patch was aborted because of concern about increased risk of complications. After magnetic resonance imaging, we proceeded with epidural blood patch with a good therapeutic result. We discuss the imaging results and safety concerns we considered when assessing the benefits and risks of epidural blood patch in this patient.