A&A practice
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Case Reports
Another Role for Angiotensin II?: Vasopressin-Refractory Shock After Pheochromocytoma Resection: A Case Report.
A patient presented with multiple unrelated tumors and was found to have a small but functional adrenal pheochromocytoma. After pheochromocytoma resection, shock developed unresponsive to vasopressin in recommended doses (0.04 U/min infusion plus repeated 1-U boluses) but responded dramatically to an angiotensin II infusion (20 ng/kg/min) with a mean arterial pressure >100 mm Hg. The patient's blood pressure was maintained for 42 hours postoperatively with an infusion rate that ranged from 2 to 38 ng/kg/min. Because vasopressin may not always be effective for postresection shock in people with pheochromocytomas, angiotensin II may prove to be an effective alternative.
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Acupuncture studies have demonstrated varying effects on pediatric postoperative nausea and vomiting (PONV). Unanswered questions include whether the type of therapy, number of points used, or timing of treatments vary the effect of acupuncture. We present a case series of intraoperative multipoint acupuncture treatments for high-risk pediatric patients. ⋯ Patients who received intraoperative acupunctur e reported no early phase PONV, and 3 patients (15.8%) reported late-phase PONV. One patient required postoperative antiemetics. Intraoperative multipoint acupuncture may be a safe and efficacious adjunct for PONV in high-risk pediatric patients.
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Tracheostomy is a weaning technique in patients requiring prolonged ventilation. During this period, complications like tube blockage, fracture of the tracheostomy tube, or cuff rupture can occur. Fracture of the tracheostomy tube can result in the distal end of the tube being dislodged further down the trachea, leading to airway obstruction and hypoxia. We report fracture of a tracheostomy tube in which the distal end was removed, using the inflation line of the pilot balloon to pull out the broken end of the tracheostomy tube.
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Case Reports
Eighteenth Century Complications With 21st Century General Anesthesia: A Case Report of Scurvy.
Autism spectrum disorder (ASD) may be associated with self-imposed dietary restrictions causing nutritional deficiencies, and the anesthesiologist must be aware of their potential clinical implications. Because humans are unable to produce ascorbic acid through endogenous metabolic pathways and children with ASD may avoid vitamin C-containing foods, vitamin C deficiency, or scurvy, may develop in patients scheduled for general anesthesia. Vitamin C deficiency may cause dysfunction in autonomic nervous system processes or pulmonary hypertension resulting in unexpected hemodynamic lability. We describe a child with ASD and limited dietary options leading to undiagnosed scurvy and intraoperative hypotension.