A&A practice
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Isaacs syndrome is a rare peripheral nerve hyperexcitability syndrome. The painful discharges in Isaacs syndrome are abolished by the blockade of the neuromuscular junction but not by peripheral nerve blocks (PNB). However, the efficacy of PNB for intraoperative and postoperative analgesia among those with Isaacs syndrome is unknown. ⋯ The patient required only a single low dose of rocuronium for intubation and surgery. On emergence from anesthesia, the patient was pain free for 6 hours and did not return to her preoperative pain state for 36 hours. PNB can be an effective means of postoperative pain control for patients with Isaacs syndrome.
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We report the case of a 21-year-old primiparous woman at 22 weeks gestation who presented with a large uncorrected ventricular septal defect, severe pulmonary hypertension, and Eisenmenger syndrome. The patient elected for termination of pregnancy, which was performed under regional anesthesia. ⋯ Thrombocytopenia and systemic anticoagulation for extracorporeal membrane oxygenation presented a challenge for removal of the epidural catheter. Pulmonary hypertension was managed and she was discharged on postoperative day 35.
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Case Reports
Anesthetic Considerations for a Patient With Chronic Systemic Capillary Leak Syndrome: A Case Report.
Systemic capillary leak syndrome (SCLS) is an idiopathic vascular hyperpermeability that leads to profound hypotension, hypoalbuminemia, and hemoconcentration. Sixty years since its inauguration into literature, SCLS is still elusive, underdiagnosed, and profoundly dangerous. ⋯ Both forms are postulated to have similar pathogenesis, yet clinical differences are noteworthy, warranting variations in perioperative management. We present a patient with chronic SCLS who underwent general and regional anesthesia for elective surgery.
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Historical Article
What Every Anesthesiologist Should Know About the Manual Resuscitation Bag.
The bag-valve-mask or the manual resuscitation bag is life-saving equipment. This article explains its construction, functioning, and limitations. This article also attempts to clarify some common misconceptions such as whether a resuscitation bag can be used to preoxygenate or provide continuous positive airway pressure or positive end-expiratory pressure and the highest percentage of oxygen that it can deliver.
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Tardiness in the operating room has been shown to decline in the day as a result of operational decisions on the day of surgery. This article studies nonoperating room anesthesia (NORA) tardiness at the University of Vermont Medical Center in cases performed in the 2015 calendar year. ⋯ On average, tardiness in NORA sites increased as the day progressed, with the exception of diagnostic radiology. This is likely due to limited tactical and operational opportunities to improve workflow.