A&A practice
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Anesthetizing children with extreme cardiopulmonary illness can be especially challenging. In adults, a host of alternatives to general anesthesia for the labile patient are available, However, in children, these techniques may be challenging due to a lack of patient cooperation. ⋯ Due to severe end-stage cardiomyopathy, the risk of general anesthesia was deemed excessive. Distraction was used to usher the patient through an awake caudal block for avoidance of general anesthesia.
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Case Reports
Catastrophic Intracardiac Thrombosis During Emergency Repair of an Expanding Aortic Pseudoaneurysm: A Case Report.
Catastrophic thrombosis is a rare but frequently fatal event following complex cardiac surgery. It is most often encountered following separation from cardiopulmonary bypass (CPB) and reversal of heparin anticoagulation, and somewhat paradoxically, at the time when bleeding from post-CPB coagulopathy is being treated. ⋯ Following a prolonged operation, she developed intracardiac thrombus during transfusion of hemostatic blood products and procoagulant agents. Potential contributing factors are discussed.
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Case Reports
Atrioesophageal Fistula After Radiofrequency Ablation Presenting With Status Epilepticus: A Case Report.
Radiofrequency (RF) ablation for atrial fibrillation is commonly performed. Atrioesophageal fistulas are an uncommon complication of RF ablation and can present with status epilepticus due to an extensive vascular air embolus. Initial treatment may require a high level of suspicion of this rare occurrence to help prevent further injury and increase the likelihood of a meaningful recovery.
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A 17-year-old boy developed postdural puncture headache after several lumbar punctures (LPs) for intrathecal chemotherapy. The pediatric anesthesiology service was consulted for an epidural blood patch (EBP). ⋯ After he woke up, blood was injected through the catheter and the headache resolved. This technique can be used in pediatric patients requiring deep sedation for an EBP.
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Case Reports
Bilateral Cavernous Sinus Syndrome, Pituitary Macroadenoma, and Postoperative Loss of Vision: A Case Report.
Postoperative vision loss is a rare complication. When visual loss does occur, it is rarely associated with ophthalmoplegia. ⋯ The patient underwent urgent excision of the macroadenoma 5 days after the onset of symptoms. Visual field deficits and associated ophthalmoplegia had completely resolved at 3-month follow-up.