A&A practice
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Central neurogenic hyperventilation (CNH) is a rare disease, caused by chemical or mechanical disturbance of respiratory centers. It is characterized by the absence of extracerebral respiratory stimuli. A woman developed severe respiratory alkalosis and lactatemia after resection of a posterior fossa meningioma despite lack of cardio-respiratory or metabolic alterations. ⋯ Treatment with mannitol and dexamethasone reestablished normal breathing patterns. Lactatemia was likely due to reduced splanchnic lactate utilization. Intracranial pathologies should be suspected in case of hyperventilation without overt reasons. cCT to confirm edema or ischemia and prompt treatment is suggested.
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Case Reports
High-Degree Heart Block During Noncardiac Surgery Soon After Transcatheter Aortic Valve Replacement: A Case Report.
Patients undergoing transcatheter aortic valve replacement (TAVR) as a bridge to noncardiac surgery have improved outcomes. Older clinical trials concluded no increased risk of performing noncardiac surgery within 30 days of the TAVR procedure. ⋯ We present a patient who received a TAVR and suffered associated complications during subsequent surgery. We further discuss preventative measures and perioperative considerations for this patient population.
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Most of the cases demonstrating describing acute findings using point-of-care ultrasound (POCUS) have been described in emergency medicine and critical care medicine. While the use of POCUS has become more prevalent in anesthesia practice, documentation of acute findings resulting in alteration in management based on real-time ultrasound findings during pediatric anesthesia remains limited. This case highlights the use of POCUS during cardiopulmonary collapse occurring during correction of neuromuscular scoliosis. POCUS excluded the presumed diagnosis of venous air embolism and identified an intracardiac thrombus leading to the diagnosis and treatment of pulmonary embolism.
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Awake combined spinal caudal anesthesia has been used as an anesthetic technique for longer-duration infraumbilical surgeries in infants. Literature on the safety and feasibility of this technique is limited. We share our experience with 27 infants undergoing longer-duration urologic surgery using awake combined spinal and caudal anesthesia without the use of systemic sedatives or inhalational agents. We describe our technique, safety considerations, and details surrounding the optimal timing of caudal catheter activation for prolongation of surgical anesthesia.
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Letter Case Reports
Unilateral Sacral Erector Spinae Plane Block: Additional Experience.