A&A practice
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A 63-year-old woman presented with cardiac tamponade because of a ruptured giant left anterior descending coronary artery aneurysm with a fistula to the main pulmonary artery. The diagnosis was made intraoperatively during an emergent subxiphoid pericardial window using transesophageal echocardiography and confirmed by intraoperative coronary angiography. Because of this prompt diagnosis, the patient was successfully managed with immediate surgical repair of the aneurysm and fistula.
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Case Reports
Anesthesia for Pygopagus Conjoined Twins During Single-Twin and Simultaneous Pneumoperitoneum: A Case Report.
We present the case of the first stage of separation of 9-month-old pygopagus conjoined twins who demonstrated minimal shared vasculature on preoperative imaging and no cross-sedation or cross-neuromuscular blockade during separate inductions of anesthesia. Laparoscopy was implemented in 1 twin at a time, then in both twins simultaneously. Despite insufflation of a single-twin's abdomen, both twins demonstrated hypercapnia and signs of a concomitant respiratory acidosis because of carbon dioxide diffusion through a shared peritoneal membrane. This is the first documented case of simultaneous laparoscopy-induced pneumoperitoneum in pygopagus conjoined twins.
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Case Reports
Transversalis Fascia Plane Block for the Treatment of Chronic Postherniorrhaphy Inguinal Pain: A Case Report.
Chronic neuropathic pain is a well-recognized complication of inguinal hernia repair. We report a 47-year-old man suffering from chronic neuropathic postherniorrhaphy pain. ⋯ We therefore performed transversalis fascia plane block with local anesthetic and steroid that resulted in long-term pain relief. This block has been successfully used in the past for providing postoperative analgesia in the L1 dermatome, but its role in chronic pain is unreported.