A&A practice
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Spinal anesthesia (SA) has been utilized for lumbar surgical procedures; however, postdural puncture headache (PDPH) and subdural hemorrhage (SDH) are potential consequences. We present the case of a 76-year-old with progressive neurogenic claudication secondary to lumbar spinal stenosis who received SA for a 2-level lumbar posterior decompression. ⋯ Our intraoperative image demonstrates the submillimeter dural defect that can potentially engender complications as significant as PDPH and/or SDH. We recommend searching for, and preemptively sealing, the dural puncture site when SA is used for lumbar spine surgery.
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Case Reports
Perioperative Management of an Adult Patient With Myoclonic Epilepsy With Ragged Red Fibers Syndrome: A Case Report.
Myoclonic epilepsy with ragged red fibers (MERRF) syndrome is a rare mitochondrial disease potentially associated with increased sensitivity to anesthesia and metabolic decompensation. We present the perioperative management in a 59-year-old man with MERRF scheduled for lipomatosis cure under general anesthesia (GA). ⋯ Propofol and sevoflurane may be used in asymptomatic MERRF adult patients. Such patients present high risk of residual neuromuscular blockade that should be monitored and reversed.
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Inaccurate anesthesia start time (AST) documentation can result in lost revenue. Using a retrospective analysis, we estimated lost revenue from inaccurate documentation of the AST within a single health care system, including academic and community-based facilities. ⋯ Of the 282,432 cases included, 25.6% had a documented "in-room" time before the documented AST, resulting in an estimated loss of $703,522 within 30-month study period. Through educational interventions and feedback, anesthesia clinicians have the potential to significantly increase revenue through more accurate documentation of AST.
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Factor X (FX) deficiency is a rare coagulopathy that may cause bleeding complications in parturients. The literature on rotational thromboelastometry (ROTEM; Instrumentation Laboratory, Bedford, MA) to guide factor repletion and neuraxial placement during partuition is limited. ⋯ Thromboelastometry may be a valuable adjunct to conventional monitoring in patient management. A limitation of this report is that coagulation tests and thromboelastometry were not assessed at identical timepoints.
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Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is associated with significant volume shifts and requires meticulous hemodynamic management. The conventional and arbitrary "liberal" and "restrictive" fluid regimens are now being challenged. ⋯ Herein, we describe a case in which point of care ultrasound of the carotid artery and derived parameters were used to guide intraoperative fluid management. We discuss the reliability of this technique and the potential advantages it could offer.