A&A practice
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An elderly patient with renal cell carcinoma underwent a robotic nephrectomy. After an uneventful intraoperative period, soon after extubation she developed generalized seizures and was diagnosed with posterior reversible encephalopathy syndrome (PRES) on neuroimaging. ⋯ PRES was attributed to compromised renal function, chronic hypertension, and the effects of pneumoperitoneum. Early diagnosis, aggressive treatment, and rehabilitation are crucial for the management and recovery of patients with PRES.
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Case Reports
Spinal Anesthesia in Elderly Patients With Femoral Neck Fractures on Apixaban Therapy: A Case Series.
This case series reviews surgeries involving elderly patients with femoral neck fractures on apixaban who underwent spinal anesthesia (SA) within 72 hours of their last dose. Despite patients being on anticoagulation, no neurological complications occurred, suggesting SA may be practical in cases where the benefits of timely surgery outweigh the potential risks, including apixaban discontinuation for a period of less than the recommended 72 hours with detectable levels of the drug remaining in the plasma. Quantitative apixaban measurements offered useful anticoagulation status insights, though safe thresholds remain undefined.
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Case Reports
Prolonged Treatment of Inappropriate Sinus Tachycardia with Continuous Stellate Ganglion Blockade: A Case Report.
Inappropriate sinus tachycardia (IST) presents challenges in diagnosis and treatment due to its unclear etiology and limited therapeutic options. This case report explores the use of continuous stellate ganglion block (CSGB) as a potential treatment avenue. ⋯ Despite the eventual recurrence of symptoms, the sustained effects of CSGB suggest its efficacy in managing IST. This report underscores the potential of CSGB as a promising therapeutic approach for IST, offering longer-lasting symptom control compared to single-injection stellate ganglion block (SGB) interventions.
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Management of refractory ventricular fibrillation (VF) in patients with implantable implantable cardioverter defibrillator (ICD) presents a therapeutic challenge. We present a case of pediatric refractory ventricular tachycardia (VT)/Torsade de Pointe managed effectively with bilateral stellate ganglion block (SGB) with a long-acting local anesthetic for 18 days as a bridge to more definitive surgical management.
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Case Reports
Digital Ischemia Secondary to Ulnar Artery Puncture Successfully Treated by Brachial Plexus Block: A Case Report.
After vascular puncture and catheterization, arteries can have many complications that impede blood flow such as vasospasm, thrombosis, and emboli generation, among other complications. Treatment depends on severity of ischemic symptoms and can range from as mild as applying local heat packs to surgical thrombectomy. We present a case of digital ischemia secondary to vascular puncture that was successfully treated with a supraclavicular nerve block, resulting in the vascular surgery team canceling an emergent surgery.