A&A practice
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Kratom is an herb indigenous to Southeast Asia with psychoactive opioid compounds, often used as a treatment for chronic pain or opiate withdrawal symptoms. It is legally and readily available via Internet sales and has been identified as an emerging drug of abuse in the United States. ⋯ At lower doses, kratom acts as a stimulant, while at higher doses, it produces analgesia and euphoria. Here, we describe the successful management of kratom overdose and withdrawal in a young man with negative toxicology screens.
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Jehovah's Witness patients have unique perioperative challenges involving blood products. We describe the use of a novel method to maintain a closed circuit between a Jehovah's Witness patient's arterial blood and the epidural space while performing a blood patch for postdural puncture headache. Previously described methods have utilized venous catheters to maintain a closed circuit between the body and the epidural space. This is the first report we are aware of that utilizes a closed-circuit arterial blood supply to create an epidural blood patch in a Jehovah's Witness patient.
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Cardiovascular disease is the leading cause of peripartum death in the United States during pregnancy. The presence of concomitant diagnoses may complicate or conflict with the management of the primary cardiovascular diagnosis and further complicate pregnancy and delivery. We describe the management of a 29-year-old, gravida 5, para 1 woman with severe peripartum cardiomyopathy during this and a previous pregnancy complicated by multiple endocrine neoplasia type and factor V Leiden thrombophilia, limiting therapeutic options and contributing to considerable perioperative management challenges.
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Pulmonary artery anastomosis stenosis is a rare cause of right ventricular failure after orthotopic heart transplantation. In this case report, direct ultrasound of the pulmonary artery helped diagnose stenosis at a location not visible on transesophageal echocardiography or even with standard epicardial ultrasound views. It is important to evaluate all vascular anastomoses after heart or lung transplantation because surgical revision of these lesions is facile, but if left undiagnosed, significant morbidity or mortality is likely.
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An 18-month-old patient with hereditary sensory and autonomic neuropathy, type VII undergoing general anesthesia for Nissen fundoplication and gastrostomy tube is presented. This is the first reported case of a patient with this particular genetic mutation receiving general anesthesia. ⋯ The anesthetic considerations and implications of caring for a patient with this particular mutation and patients with other variations of hereditary sensory and autonomic neuropathy are also discussed. We show that a patient with de novo hereditary sensory and autonomic neuropathy, type VII without anhidrosis did not require intraoperative narcotics and did not experience bradycardia, asystole, or hemodynamic compromise.