A&A practice
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Extrinsic compression of the heart consequent to intrapleural fluid is a rare cause of cardiac tamponade. Cases of massive hemothorax resulting in external cardiac tamponade due to injury of the internal thoracic artery (ITA) following blunt or penetrating trauma have been described in the literature. ⋯ It manifested as hemodynamic instability that persisted despite aggressive fluid resuscitation. Investigation with an intraoperative transesophageal echocardiogram demonstrated cardiac tamponade secondary to a massive hemothorax which resolved following surgical placement of an intercostal drain.
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In this case, a 79-year-old male presented with new anteroseptal Q waves and T-wave inversions across the precordial leads following an otherwise uneventful endovascular repair of his thoracoabdominal aortic aneurysm. The patient had no history of cardiac disease and had undergone a dobutamine stress echocardiogram within the preceding 6 months that showed no evidence of inducible ischemia. Nevertheless, routine postoperative electrocardiogram (EKG) revealed new Q waves and T-wave inversions and transthoracic echocardiogram that demonstrated akinesis of the left ventricle (LV) apex with chronic-appearing apical thrombus. We will further discuss preoperative evaluation of cardiovascular risk along with postoperative interpretation of EKG abnormalities.
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With the ongoing development of safer anesthesia, pregnant women with cardiac disease are presenting more frequently for cesarean delivery. We report the successful anesthetic management of a 31-year-old parturient, on long-term anticoagulant therapy, who presented with acute cardiac tamponade due to perforation of the left atrium from a dislodged atrial septum defect occluder. The cesarean delivery was followed by temporary repair of the perforation without extracorporeal circulation (EC) due to concerns about excessive postpartum bleeding. The definitive repair of the atrial defect and the perforation were successfully accomplished under (EC) 5 days after delivery.
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Perioperative difficult airway management is one of the most challenging tasks encountered by anesthesiologists. Awake intubation is considered the gold standard in securing the anticipated difficult airway. ⋯ We report a case of a monolingual Arabic-speaking patient with a difficult airway who required awake intubation to undergo surgery. Google Translate, a free and accessible translation software application, was used during his awake intubation-we recommend such an approach to be considered to reduce anxiety and facilitate success by providing concise, real-time instruction in the patient's preferred language.