A&A practice
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The use of local anesthetics for improved pain management is well established. However, significant morbidity may be caused by local anesthetic systemic toxicity (LAST) from inadvertent intravascular injection or excessive dosing of local anesthetics. Despite incomplete understanding of the mechanism of action of intravenous lipid emulsions (ILE), their use has become a first-line therapy for treating LAST. We present a case report of LAST, successfully treated with ILE with a secondary effect of complete reversal of a successful peripheral nerve block as quickly as the LAST symptoms resolved.
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Amniotic fluid embolism (AFE) is a rare but devastating condition with mortality rates as high as 60%-80%., We report a case of AFE complicating the labor of a parturient with no reported risk factors. She received general anesthesia for emergent cesarean delivery (CD), after which she developed a pulseless electrical activity (PEA) event requiring resuscitation, disseminated intravascular coagulation, and postpartum hemorrhage with undetectable fibrinogen activity by ROTEM FIBTEM assay. Extracorporeal membrane oxygenation (ECMO) therapy was successfully initiated, and she was discharged home without neurologic sequelae. ECMO therapy can be considered for the treatment of AFE even in the absence of fibrinogen activity.
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We report a case of severe shivering resulting in rhabdomyolysis while on venoarterial extracorporeal membrane oxygenation (ECMO) that resolved after hyperthermia was induced using the ECMO circuit. The patient developed shivering approximately 24 hours after venoarterial ECMO cannulation for refractory ventricular tachycardia. ⋯ Suspecting sepsis as the etiology of shivering, the ECMO circuit temperature was increased to 38 °C, and the shivering was resolved. This case demonstrates therapeutic hyperthermia to treat infection-induced severe shivering and rhabdomyolysis while on ECMO.
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We present the case of a 7-month-old infant undergoing thoracotomy and left lower lobe lobectomy who experienced a significant complication related to lung isolation with a bronchial blocker. Despite good isolation and seemingly appropriate positioning, the bronchial blocker became entrapped within the staple line at the bronchial stump. Fortunately, the surgeon was able to free the blocker. Going forward, we recommend clinicians be vigilant in positioning the blocker just distal to the carina in all cases and, further, consider retracting the blocker into the trachea before surgical intervention on the airway to avoid inadvertent entrapment of the device.