A&A practice
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Patients with aortic stenosis (AS) and other significant cardiopulmonary comorbidities are vulnerable to hemodynamic instability during anesthesia. This case report compares the use of remimazolam and midazolam in a 71-year-old man with symptomatic AS, chronic kidney disease, and ischemic cardiomyopathy. ⋯ While moderate sedation with midazolam resulted in significant hypotension, use of remimazolam in subsequent procedures demonstrated a stable hemodynamic profile despite increased disease burden. This report highlights the potential advantages of remimazolam compared to midazolam in high-risk patients undergoing interventional radiology procedures.
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Management of neuraxial catheters mandates consideration of comorbid conditions requiring anticoagulation, which may complicate their management. Cangrelor is an intravenous P2Y12 inhibitor with a plasma half-life of 3 to 6 minutes. ⋯ We present a case of a patient with an epidural catheter in situ who became critically ill, requiring antiplatelet therapy with cangrelor. We discuss pertinent considerations of neuraxial techniques in patients requiring cangrelor therapy and review existing guidelines for the management of these patients as well as current evidence of the use of platelet function tests in this setting.
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Case Reports
Anesthesia for Cesarean Delivery in a Patient With Spondylocostal Dysostosis: A Case Report.
Spondylocostal dysostosis (SCD) is an inherited skeleton growth disorder characterized by abnormalities of the vertebrae and ribs. Individuals are susceptible to kyphoscoliosis and pulmonary complications, which may be exacerbated by respiratory physiologic changes in pregnancy. We present a case of a parturient with severe kyphoscoliosis and restrictive lung disease who received a modified rapid sequence induction and transabdominal plane blocks for cesarean delivery. Our case describes the safe administration of general anesthesia for cesarean delivery and reviews the anesthetic considerations for managing patients with SCD.
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Holistic review of applications may optimize recruitment of residents by seeking out characteristics best aligned with program culture. The goals of this mixed methods research were to engage residency recruitment stakeholders to develop a holistic scoring rubric, measure the correlation between the rubric score and the final global rating used to rank applicants for the National Resident Matching Program Match, and qualitatively analyze committee discussions at the end of the interview day about applicants for potential unconscious biases. ⋯ Stakeholder-driven holistic review that more broadly emphasizes an applicant's experiences and attributes can be successfully implemented in evaluating residency applicants. Committee discussions revealed various biases that warrant further investigation and mitigation strategies.