A&A practice
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We report a case of Xp21 deletion syndrome, a contiguous gene syndrome associating glycerol kinase deficiency, Duchenne muscular dystrophy, and congenital adrenal hypoplasia. This results in a contraindication to the use of all halogenated agents and of propofol. ⋯ We were unfortunately unable to document the metabolic consequences of this glycerol load. We suggest that if propofol is deemed necessary in such cases, it should only be used as a bolus dose of a 2% solution.
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When incorporated into the 10-second pulse/rhythm check of the advanced life support (ALS) protocol, focused cardiac ultrasound is a useful adjunct to cardiopulmonary resuscitation. In this case series, we demonstrated the feasibility of echocardiographic assessment using subcostal-only view in ALS (EASy-ALS) performed by anesthesiology residents during the periresuscitative period after structured training. Residents obtained diagnostic quality images in 100% of the self-reported cases, which enabled them to identify cardiac motion and potentially reversible causes of hemodynamic instability. Implementation of EASy-ALS into practice requires system-wide changes in cardiac arrest management for consistency, quality, and further evaluation of patient outcomes.
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Case Reports
An Unresponsive Patient in Postanesthesia Care Unit: A Case Report of an Unusual Diagnosis for a Common Problem.
An unresponsive patient in the postoperative period is a serious complication that can be caused by anesthetics. However, nonanesthetic causes should also be considered. ⋯ We further describe a systematic approach to the unresponsive patient in the postanesthesia care unit (PACU). While not an uncommon occurrence, catatonia is a complex psychomotor syndrome that can be difficult to diagnose; however, catatonia should be considered in unresponsive postoperative patients.
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Case Reports
Epidural Blood Patch for Postdural Puncture Headache in a Patient With Coronavirus Disease 2019: A Case Report.
The safety of epidural blood patch in patients with coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unknown. Here, we report a single case of epidural blood patch to treat a postdural puncture headache in a woman after spinal anesthesia for cesarean delivery. The patient's headache was relieved, and she did not develop any other neurological symptoms.
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Case Reports
Intraoperative Diagnosis of Subaortic Stenosis in a Young Patient Scheduled for Elective Aortic Valve Replacement.
A 25-year-old patient with a history of aortic stenosis due to presumed bicuspid aortic valve presented for elective aortic valve replacement. Intraoperative transesophageal echocardiography (TEE) revealed a trileaflet aortic valve but detected the presence of a subvalvular membrane. ⋯ Successful resection resulted in relief of the obstruction. Compared with preoperative transthoracic echocardiography, TEE was able to correctly characterize the nature of the stenosis with area determination accurately provided by application of 3D techniques.