A&A practice
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The acceptable platelet count for the safe provision of neuraxial anesthesia in obstetric patients is unknown. Comorbidities may sway a provider to perform neuraxial anesthesia, despite thrombocytopenia, as the putative risk of spinal-epidural hematoma may not outweigh the risks associated with general anesthesia. The case of a 22-year-old nulliparous woman undergoing a cesarean delivery with a new diagnosis of pulmonary hypertension and right heart failure, compounded with thrombocytopenia and possible Hemolysis, Elevated Liver Enzyme, and Low Platelet (HELLP) syndrome, is presented. Risks and benefits of general versus neuraxial anesthesia in this specific setting are reviewed.
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Case Reports
Postoperative Dexmedetomidine-Induced Polyuria in a Patient With Schizophrenia: A Case Report.
We present a patient with schizophrenia who developed dexmedetomidine-induced polyuria after superficial parotidectomy. Two hours after starting the dexmedetomidine infusion, urine output increased from a baseline rate of 80 mL/h to a 7-hour average rate of 400 mL/h (range, 280-560 mL/h), the serum sodium concentration increased from 132 to 139 mEq/L, and urine-specific gravity was 1.006. Following dexmedetomidine discontinuation, the urine output decreased to an average of 66 mL/h (range, 40-100 mL/h). Close monitoring of urine output and serum sodium concentration may be indicated during dexmedetomidine infusion.
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Case Reports
Awake Craniotomy in a Patient With History of Post-Traumatic Stress Disorder-A Clinical Dilemma: A Case Report.
A 32-year-old man undergoing awake craniotomy for tumor resection was previously diagnosed with post-traumatic stress disorder (PTSD)-typically a relative contraindication for awake craniotomy. Preoperative neurocognitive assessment and counseling by a neuroanesthesiologist and neuropsychologist were undertaken to characterize his PTSD, identify triggers, and prepare him for the intraoperative events. ⋯ With an emphasis on open communication, the patient tolerated the awake craniotomy without complications. This case highlights the importance of multidisciplinary approach and meticulous perioperative preparation in successfully managing a patient who might otherwise be contraindicated for awake craniotomy.
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Case Reports
"Choledochoscope" as an Important Addition in Difficult Airway Management: A Case Report.
The choledochoscope is an additional tool to manage a difficult airway. We successfully used it for the first time for awake nasal intubation in a patient with no mouth opening resulting from bilateral temporomandibular ankylosis. ⋯ However, the shorter length and larger diameter of the choledochoscope in comparison with the fiberoptic bronchoscope are crucial limiting factors of this method. We, therefore, suggest considering a choledochoscope for intubation in patients with difficult airway as a second-line alternative when a fiberoptic bronchoscope is not available.