A&A practice
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Case Reports
Orthotopic Liver Transplant in a Patient Anticoagulated With Rivaroxaban: A Case Report.
Direct oral anticoagulants are approved for use in the United States and Europe and are increasingly used in chronic liver disease patients who have or are at risk of thrombotic events. While these drugs are clinically attractive because no monitoring is required, the risks and benefits in patients with hepatic or renal insufficiency who undergo surgery remain unclear. In this report, we describe the perioperative consequences, safety issues, and lessons learned from a patient undergoing an orthotopic liver transplant who was anticoagulated with rivaroxaban due to partial superior mesenteric vein thrombosis.
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Case Reports
Retrieval of a Bravo Probe Dislodged Into the Laryngopharynx With Minimal Delay in Ambulatory Care: A Case Report.
Esophageal pH monitoring via wireless probes is used to evaluate chest pain and atypical symptoms and diagnose gastroesophageal reflux. These probes are commonly placed during esophagogastroduodenoscopy performed by gastroenterologists in an ambulatory anesthesia setting. Dislodgment and aspiration of these probes can cause morbidity, require surgical removal, and involve the anesthesia provider in prolonged emergency care. We present a case of a probe dislodgment where aspiration was avoided and describe how retrieval of this device is different from typical hypopharyngeal foreign body removal.
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Case Reports
Urgent Complex Intraoperative Reintubation in a Known Difficult Airway After Endotracheal Tube Damage: A Case Report.
Treacher Collins syndrome is an inherited disorder resulting in maldevelopment of the first and second branchial arches. Patients have complex orofacial anatomy often requiring airway interventions from birth. ⋯ Due to the patient's unique anatomy, a fiberoptic bronchoscope and ventilating exchange catheter were utilized together to facilitate a nasotracheal tube exchange. This case demonstrates the utilization of a combination of advanced airway techniques in an urgent perioperative setting.
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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.