A&A practice
-
Human 4-factor prothrombin complex concentrate (4F-PCC) may reduce blood loss during surgery. This case series described perioperative outcomes among 9 patients who refused standard allogeneic blood transfusion, underwent complex cardiac surgery with aortic involvement, and received intraoperative 4F-PCC. ⋯ Outcomes included postoperative death (n = 1), major postoperative bleeding (n = 1), deep vein thrombosis (n = 2), and ischemic stroke (n = 1). When standard allogeneic blood transfusion is refused, viable hemostasis can be obtained using 4F-PCC during complex cardiac surgeries with a high risk of bleeding.
-
Vasodilatory shock is common following cardiac surgery, caused by an inflammatory response to cardiopulmonary bypass (CPB). Some cases are refractory to volume resuscitation, high-dose catecholamines, arginine vasopressin, and established adjunctive therapies. Angiotensin II (ANG-2), an endogenous hormone in the renin-angiotensin-aldosterone system (RAAS), has several direct and indirect vasoconstrictive properties that make it a promising potential treatment. This case describes the successful use of ANG-2 in an anephric patient who suffered from severe refractory shock following CPB, offering a unique potential mechanism of benefit in a broader population of patients with baseline impaired RAAS.
-
Case Reports
Challenges Faced During the Ventilation of a Child With Bronchobiliary Fistula: A Case Report.
Hepatoblastoma is the most frequently occurring malignant tumor of the liver in children (ages ≤5 years). The formation of bronchobiliary fistula is a rare complication. We present a case report that describes the associated anesthetic challenges that we encountered for the treatment of this pathology.
-
While epidural analgesia is generally considered safe in parturients with common spinal cord injuries, little is known about the safety or efficacy of this technique in patients with Brown-Séquard syndrome, a rare disorder consisting of 2% of traumatic spinal cord injuries. We present a case of successfully placing and managing a labor epidural in a patient with Brown-Séquard syndrome who developed a dense block with minimal local anesthetic requirements. To minimize trauma and preserve potentially vulnerable remodeled neural pathways, we recommend cautious, slow epidural medication dosing and use of neuraxial ultrasound rather than landmark-based techniques in these patients.