A&A practice
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Complex abdominal wall hernia repairs can have high failure rates. Many surgical techniques have been proposed with variable success. ⋯ Toxin was administered into the 3 abdominal wall muscle layers under ultrasound guidance at multiple sites 2 weeks before surgery. The resulting flaccid paralysis of the abdominal musculature facilitated a successful primary surgical closure with no postoperative complications.
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Shoulder surgery in the beach chair position is routinely performed, and central neurological events are rare but potentially devastating. We present a patient with transient neurological deficits after a sudden blood pressure drop with a simultaneous decrease of regional cerebral saturation values registered by cerebral oximetry. We reviewed published cases and proposed possible strategies to prevent the occurrence of similar complications in this context.
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We report the case of a 55-year-old woman who required extracorporeal membrane oxygenation for extreme respiratory distress after a liver transplant and eventually died. As is so often the case, this patient's values and wishes were not documented before she had a risky surgical procedure. Anesthesiologists, in partnership with surgeons, can participate in preoperative discussions exploring wishes and values and document them in advance directives which will help clinicians respect patients' preferences.
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Case Reports
Transnasal Sphenopalatine Ganglion Block for Postdural Puncture Headache in an Adolescent: A Case Report.
We present a pediatric patient with postdural puncture headache after a lumbar puncture, who was successfully treated with a sphenopalatine ganglion block. An uneventful autologous epidural blood patch had been placed 2 days before, but the patient reported a recurrence of symptoms after about 5 hours. Sphenopalatine ganglion block is well described in the treatment of postdural puncture headache for the obstetric population, but examples of its use in the pediatric population are not described. To our knowledge, this is the first pediatric case of sphenopalatine ganglion block for postdural puncture headache reported in the literature.
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Case Reports
Peripartum Hyperkalemia Caused by Magnesium Infusion in a Woman With End-Stage Renal Disease: A Case Report.
Pregnancy in the setting of renal failure has higher rates of adverse events necessitating increased monitoring and treatment. Pregnant women with end-stage renal disease have higher rates of hypertension, and 50% of pregnancies are complicated by preeclampsia. ⋯ The magnesium infusion was stopped, and the patient underwent emergent hemodialysis with subsequent improvement. Hyperkalemia caused by magnesium infusion is a rare and not very well-understood phenomenon.