A&A practice
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Case Reports
Anesthetic-Induced Intraoperative Dream Associated With Remission of a Psychiatric Disorder: A Case Report.
Trauma is associated with debilitating acute and posttraumatic stress disorders, which have limited treatment options. We report on a patient undergoing surgical hand repair after a recent knife attack who experienced vivid dreaming and subsequent remission of acute stress disorder. ⋯ While intraoperative dreaming is common, this case details potential associations between anesthetic state, dreaming, intraoperative electroencephalography, and remission of a psychiatric disorder. Our experience suggests a novel intervention for stress disorders.
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Takayasu's arteritis is a persistent chronic progressive inflammation of the large- and medium-caliber arteries. Controlling cardiovascular variability during anesthesia and overcoming difficulties of cardiovascular monitoring due to the impaired vessels are important in patients with Takayasu's arteritis. ⋯ We report the case of a patient with Takayasu's arteritis who underwent oral surgery under general anesthesia. This report highlights the use of remimazolam and remifentanil to reduce hemodynamic perturbations using estimated continuous cardiac output monitoring.
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Loss of consciousness suddenly occurred in 2 healthy and nonsmoking patients undergoing bipolar resection for intramural myomas under spinal anesthesia. One patient had nystagmus and emesis. In both cases, neurological symptoms were of short duration. ⋯ Carbon monoxide (CO) is a product of diathermic vaporization and may enter the blood and cause intraoperative cardiovascular symptoms. These are the first cases with neurological presentation. The CO poisoning was probably diagnosed early because the patients were awake.
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The use of mechanical circulatory support (MCS) devices continues to expand in cases of refractory cardiogenic shock. Bleeding is one of the most common complications associated with MCS, and management can be challenging due to need for systemic anticoagulation. ⋯ We describe a case of a patient supported by a right ventricular assist device with an oxygenator and a left ventricular assist device who developed pulmonary hemorrhage that was successfully treated with nebulized tranexamic acid (TXA). Following a 5-day treatment course, bleeding resolved, no adverse side effects were noted, and systemic anticoagulation was resumed.
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Lance-Adams syndrome (chronic post-hypoxic myoclonus) is a rare syndrome occurring in patients after cardiopulmonary resuscitation. Awareness of this condition is important to distinguish it from myoclonic status epilepticus, which is a poor prognostic sign. ⋯ Brain computed tomography, magnetic resonance imaging, and an electroencephalogram were used to rule out other causes of myoclonus. In this report, we discuss the diagnosis, treatment, and prognosis of patients with Lance-Adams syndrome.