A & A case reports
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A 61-year-old female ex-smoker presented with a suspicious right lower lobe mass after previously undergoing a left pneumonectomy. Due to the peripheral nature of the lung lesion, a right thoracoscopic wedge resection was proposed by the surgical team. ⋯ The trachea was extubated in the operating room, and the patient recovered uneventfully from the procedure. This case demonstrates the feasibility of limited thoracoscopic lung resections postpneumonectomy with the use of high-frequency jet ventilation.
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Hyphema, an ophthalmic pathology characterized by blood accumulation in the anterior chamber of the eye, has never been linked to administration of general anesthesia. We present the case of a spontaneous hyphema occurring on emergence from general anesthesia in a postlaparoscopic appendectomy patient. A valsalva-like maneuver with breath-holding during stage II of emergence or during CO2 insufflation may have led to the development of hyphema.
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Thresholds for platelet counts in patients at risk for bleeding are often used before surgery. We present a case report of a 13-year-old female with chronic idiopathic thrombocytopenia purpura for dental extraction with a platelet count of 4 × 10 L. Usually, therapies including platelet infusions, IV immunoglobulin, or corticosteroids would be used to increase platelet numbers. In this patient, rather than using any of these prophylactic therapies preoperatively, we used a "watchful waiting" strategy with a multidisciplinary team, the use of tranexamic acid and the aforementioned therapies available only as "rescue" agents.
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Patients with glutaric aciduria type I are at risk for acute striatal injury precipitated by catabolic stress. Here, we report the successful interdisciplinary anesthetic and perioperative management of a child with glutaric aciduria type I undergoing cardiac surgery with extracorporeal circulation. Given the central focus on prevention of acute striatal injury, our anesthetic strategy emphasized avoiding a high protein load, high-dose inotropics, especially epinephrine (associated with impaired glucose utilization), deliberate hyperventilation, and other interventions associated with systemic inflammatory response.
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An 8-year-old girl with McCune-Albright syndrome presented for resection of a very large fibrous dysplasia mass of the face with significant distortion of the airway anatomy. She had significant obstructive sleep apnea with daytime somnolence and hemoglobin oxygen desaturations while breathing room air preoperatively. We were able to successfully manage her airway by providing IV sedation, topical anesthesia of the airway, and oral fiberoptic intubation in close collaboration with our otorhinolaryngology colleagues.