A&A practice
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Case Reports
Diagnosis of an Additional Ventricular Septal Defect by Observing Dark Blood in Aortic Root Vent: A Case Report.
Diagnosis and management of multiple ventricular septal defects still remain a challenging task. Although many new diagnostic modalities have been used for the perioperative diagnosis of ventricular septal defects, the discovery of residual or additional shunts in the postoperative period is not uncommon. We report a case where we observed an undiagnosed additional ventricular septal defect shunting deoxygenated dark blood into the aortic root vent during deairing of the heart, which was confirmed on transesophageal echocardiography and addressed with reinstitution of cardiopulmonary bypass.
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Cardiac disease is one of the leading causes of maternal mortality in developed countries. The presence of a mechanical valve is a predictor of cardiac complications in obstetric patients, likely due to the challenges associated with pregnancy hypercoagulability and the imperative of meticulous management of anticoagulation throughout pregnancy, delivery, and the postpartum and to prevent the devastating event of a mechanical valve thrombosis. We report on the management of a pregnant woman with a mechanical aortic valve found to have a thrombus at 37 weeks gestation. It was decided to perform cesarean delivery to allow for a reoperative mechanical aortic valve replacement 24 hours thereafter.
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Case Reports
Nebulized Lidocaine in the Treatment of Refractory Postoperative Laryngospasm: A Case Report.
Intraoperative laryngospasm occurs in <1% of cases. Recurrent laryngospasm is rarer. ⋯ Nebulized lidocaine is used to anesthetize the vocal cords before awake fiberoptic intubation. This case highlights the novel use of nebulized lidocaine to successfully treat refractory postoperative laryngospasm in a fully conscious adult patient after conventional measures were unsuccessful.
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Dental injury is a common cause of malpractice claims involving anesthesiologists. Inadequate preoperative dental evaluations and incomplete documentation are often cited as contributing factors during reviews of closed claims. Point-of-care smartphone photographs are widely used in other medical fields such as dermatology and plastic surgery. We discuss the use of smartphone photographs for documenting preoperative dental examinations.
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Heparin is the only well-established anticoagulant medication for cardiopulmonary bypass making selecting an alternative anticoagulant challenging in patients with heparin-induced thrombocytopenia. Other anticoagulant medications can cause significant postoperative bleeding, especially in patients with end-stage renal disease. We present a case of a 63-year-old woman requiring aortic valve replacement with a history of heparin-induced thrombocytopenia and end-stage renal disease. Cangrelor and heparin were successfully used during cardiopulmonary bypass, offering an option for anticoagulation management for a uniquely challenging patient population.