A&A practice
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Case Reports
Cardiac Tamponade Caused By Carbon Dioxide Insufflation During Robot-Assisted Thoracic Surgery: A Case Report.
Various complications can occur during robot-assisted thoracic surgery for mediastinal tumors owing to carbon dioxide (CO2) insufflation. This study reports the case of a 43-year-old woman who underwent robot-assisted surgery for an anterior mediastinal tumor with the subxiphoid approach. ⋯ Cardiac tamponade due to entry of CO2 gas into the pericardial cavity was suspected. A deliberate incision was made in the right pericardium, ultimately resolving the cardiac tamponade and substantially improving the patient's blood pressure.
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Ultrasound-guided percutaneous cryoneurolysis of the intercostal nerves is an effective analgesic modality for the management of postmastectomy pain syndrome. The duration of analgesia provided by intercostal cryoneurolysis for chronic postmastectomy pain syndrome may vary. ⋯ In this case report, we describe the repeated use of ultrasound-guided cryoneurolysis of the intercostal nerves to manage chronic postmastectomy pain for 2.5 years. No adverse events or long-term neurologic sequelae were reported.
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Spondylometaphyseal dysplasia (SMD) is a rare genetic disorder affecting skeletal growth and development presenting anesthesiologists with many perioperative challenges. We present a case of a patient found to have multilevel tracheal stenosis due to twisting and folding of his trachea. ⋯ Structural and functional abnormalities of the trachea have not been reported in SMD. This is the first description of a patient with SMD with severe multilevel tracheal disease requiring tracheal reconstructive surgery.
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Case Reports
Point-of-Care Ultrasound Aids in the Management of Patient Taking Semaglutide Before Surgery: A Case Report.
Semaglutide, a glucagon-like peptide-1 (GLP-1) analog, has various effects on the gastrointestinal tract. In patients undergoing anesthesia delayed gastric emptying time can have sequelae if not identified preoperatively. Modalities include thorough history regarding the last dose administration of a GLP-1 analog and ultrasound of gastric contents before induction of anesthesia. We present a case in which gastric ultrasound identified a patient at increased risk for aspiration on induction and allowed for appropriate alterations in the anesthetic plan.
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A 63-year-old man with stage 3a chronic kidney disease (CKD) and mild hyperkalemia was scheduled for a robot-assisted prostatectomy. He was being treated with lisinopril. ⋯ Three hours after incision, electrocardiographic signs of hyperkalemia manifested with the serum potassium concentration rising to 8 mmol/L. Although hyperkalemia is a common and well-documented side effect of angiotensin-converting enzyme inhibitors in patients with CKD, we report an extreme increase in potassium within a very short time period despite prior drug discontinuation.