A&A practice
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We present the anesthetic management of a 23-year-old gravida 2 para 0-0-1-0 with a history of mitral valve replacement secondary to congenital mitral dysplasia. The hemodynamic changes of pregnancy had resulted in severe functional mitral stenosis of her mechanical valve, which was significantly undersized for her current body surface area. Her complex cardiac history required our multidisciplinary team to focus on peripartum anticoagulation management, extracorporeal membrane oxygenation (ECMO) preparation under a dural puncture epidural (DPE) technique, and managing the hemodynamic changes that are critical for a congenital heart disease parturient.
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Guidelines on the management of lumbar drain in patients receiving antithrombotic therapy are lacking, with American Society of Regional Anesthesia and Pain Medicine (ASRA) anticoagulation guidelines for regional anesthesia providing the best possible guidance for this scenario. However, the risk-benefits of placing a lumbar drain in the context of vascular surgery differ from placement of neuraxial blockade. One of the changes included in the recently published ASRA guidelines is that clopidogrel can be started on a patient with an indwelling neuraxial catheter. We report a case of slowly evolving epidural hematoma following the initiation of clopidogrel therapy in a patient with an indwelling lumbar drain.
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Case Reports
Systemic Air Embolism in a Patient With Lung Lesion Undergoing Neurosurgery in Sitting Position: A Case Report.
Systemic air embolism secondary to venous air embolism is a known complication of sitting position surgery. However, the possibility of an isolated systemic air embolism must be considered, especially in patients with preexisting lung disease receiving positive pressure ventilation. These patients may benefit from a comprehensive preoperative evaluation and advanced intraoperative monitoring. We report a case of a 53-year-old woman with chronic obstructive airway disease and a preexisting fibrocavitary lung lesion, who developed isolated air entrainment into the left heart during sitting position surgery.
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This case report describes a neonate with tracheal aplasia first diagnosed after birth due to the presentation of respiratory distress, absence of crying, and unsuccessful tracheal intubation. The most common finding with tracheal aplasia is polyhydramnios. ⋯ The only lifesaving treatment available is ventilation through esophageal intubation or tracheostomy. However, in some cases, tracheostomy is not an option.
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Methyl CpG binding protein 2 (MECP2) duplication syndrome is a rare X-linked genetic disease. Core phenotypes include infantile hypotonia, developmental delay, and minimal speech with mild dysmorphic features. Many have refractory epilepsy and recurrent infections, which are the leading causes of mortality. This article presents a case of a patient with MECP2 duplication syndrome who required general anesthesia for respiratory workup and reviews the anesthetic management for these patients, which includes induction technique, choice of drugs, and other major anesthetic concerns.