A & A case reports
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During a posterior segmental spinal fusion procedure, a 71-year-old woman developed cardiac and pulmonary embolism characterized by nonsustained ventricular tachycardia during cement injection, rapid and severe hypoxemia, and hemodynamic instability. Management included exploratory cardiotomy under cardiopulmonary bypass and removal of the emboli from the pulmonary vessels. Postoperative recovery was successful, and the patient was discharged without sequelae. We discuss the pathophysiology of bone cement implantation syndrome during spinal fusion, possible causative factors, and treatment alternatives.
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Inherited Factor V deficiency is a rare bleeding disorder. We describe the genetic analysis and anesthetic management of a parturient with severe Factor V deficiency who presented in spontaneous labor. Good hemostatic conditions were obtained with prophylactic fresh frozen plasma administration of 10 mL/kg. Detailed genetic analysis by next-generation sequencing identified several relevant mutations in the coding part of the Factor V (F5) gene in our patient, her parents, and the newborn.
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Uterine dehiscence is a known but uncommon complication during pregnancy. The symptoms of uterine dehiscence can be subclinical and usually occur during prolonged augmented labor in women who had previous cesarean delivery and/or are carrying a macrosomic baby. ⋯ However, to our knowledge, spontaneous uterine dehiscence during performance of spinal anesthesia for an elective cesarean delivery has not been reported in obstetric anesthesia practice. Here, we report a case of uterine dehiscence while subarachnoid block was being performed.
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We report the case of a 25-year-old female scheduled for laparoscopic gynecologic surgery under general anesthesia. At the end of laparoscopy, an intraperitoneal infiltration (ropivacaine 0.75%, 20 mL) was administered by the surgeon without informing the anesthesiologist. ⋯ An infusion of 20% lipid emulsion was successful in converting the ventricular arrhythmia to a sinus rhythm. This overdose could have been avoided with better communication between anesthesiologist and surgeon.