A&A practice
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Anemia occurs in a significant group of patients with bladder cancer before radical cystectomy. Iron deficiency is a readily identifiable cause of anemia, which can be treated before surgery. ⋯ Iron studies found 30% of patients had iron deficiency anemia. These findings present an opportunity to treat anemia before surgery, to reduce blood transfusions during radical cystectomy.
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The fundamental perioperative concern for patients with implantable cardioverter-defibrillators (ICDs) is the potential for electromagnetic interference (EMI) from monopolar electrosurgery. The ICD may interpret electromagnetic signals as a tachyarrhythmia and deliver an inappropriate shock to the patient. ⋯ We report a case in which magnet placement over an ICD failed to suspend tachyarrhythmia therapy because of imprecise magnet positioning. This case demonstrates the possibility for error when relying on a magnet to suspend tachyarrhythmia therapies.
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Thoracotomies are classified as moderate to high-risk surgeries due to the preponderance of complex anatomic structures, cardiac dysrhythmias, and respiratory insufficiency. The right vagus nerve innervates the sinoatrial node and controls the heart rate. ⋯ The occurrence of sudden asystole due to left vagus nerve stimulation is extremely rare. We report an unusual case of intraoperative asystole related to electrosurgical stimulation of the left vagus nerve that required cardiopulmonary resuscitation and cardiac massage.
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Burning mouth syndrome is a chronic pain condition characterized by a burning sensation of the oropharynx. The pathophysiology of burning mouth syndrome includes peripheral and central sensitization. ⋯ Low-dose naltrexone has been reported to provide analgesia in central sensitization states and was successful in reducing pain severity in our patient. We conclude that low-dose naltrexone may be a therapeutic option for patients with burning mouth syndrome who are refractory to conventional therapies.
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Recent studies have demonstrated that vasopressors can be delivered safely through peripheral intravenous lines. While norepinephrine is usually delivered at a concentration of 16 to 32 μg/mL, out of concern for extravasation and interstitial necrosis, some patients receive more dilute norepinephrine solutions through peripheral intravenous catheters. ⋯ After the incident, the institutional policy changed to recommend normal saline as the default diluent for peripheral norepinephrine, with a more concentrated option available. The incident also informed similar guidelines at other hospitals.