A&A practice
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Carbon dioxide gas emboli is a potentially fatal complication that occurs more frequently during laparoscopic hepatectomy compared to other laparoscopic surgeries. The patient featured in this report had massive gas embolism confirmed by intraoperative transesophageal echocardiography (TEE) that were associated with episodes of severe hypoxemia, hemodynamic instability, and right ventricular failure requiring conversion to open hepatectomy. Abrupt abdominal decompression resulted in massive hemorrhage from a previously undetected defect in the middle hepatic vein. The report demonstrates the successful management of gas embolism during laparoscopic hepatectomy even with a significant delay in vascular repair and highlights the critical role of TEE.
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We report a case of a parturient with severe cardiac disease requiring elective termination of pregnancy. The patient underwent successfully monitored anesthesia care using remimazolam for dilation and curettage. ⋯ Remimazolam is an ultrashort acting benzodiazepine that is being used with increasing frequency in short procedures requiring sedation. Patients with complex cardiac comorbidities undergoing surgical procedures may receive maximum benefit from this novel medication due to its stable hemodynamic profile and rapid metabolism.
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Intercostal neuralgia can be debilitating and extremely difficult to treat despite multi-modal therapies. The literature describing the role of neuromodulation in patients with intercostal neuralgia is scarce. In this medically challenging case report, we describe a 56-year-old male with a near complete resolution of intractable chronic intercostal neuralgia, secondary to traumatic rib fractures and multiple surgical interventions, with a single lead thoracic spinal cord stimulator (SCS) implant. Neuromodulation therapies should be considered as a viable option for this patient population.
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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.