A&A practice
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We report the anesthetic management of 2 patients with Lennox-Gastaut syndrome presenting for respective epilepsy surgery with intraoperative electrocorticography. Electrocorticography is a useful tool to guide the localization of the epileptogenic focus for surgical resection in epilepsy surgery. ⋯ We observed that dexmedetomidine-based anesthesia facilitates intraoperative electrocorticography monitoring. Dexmedetomidine, by decreasing the requirements of other anesthetic agents, offers better recovery profile and pain relief with minimal respiratory depression in patients undergoing disconnective epilepsy surgeries.
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Hereditary neuropathy with liability to pressure palsies is an autosomal dominant condition occurring in up to 16 per 100,000 people and predisposes to neural compressive injury. Given the rarity of this condition, no guidelines currently exist for the anesthetic management of hereditary neuropathy with liability to pressure palsies. We describe the management of analgesia during labor in a woman diagnosed with hereditary neuropathy with liability to pressure palsies and a history of nerve palsy after obstetric anesthesia. Our report highlights the necessity of clinician awareness of hereditary neuropathy with liability to pressure palsies and the anesthetic precautions used to successfully avoid neural injury in this case.
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We report kinking of the pilot line of an endotracheal tube (ETT). The anesthesiologist found it difficult to deflate the ETT cuff after performing test inflation with air before intubation. ⋯ This examination revealed stenosis of the pilot line at the entry into the ETT, making it too narrow for air to flow freely during cuff deflation. The present case emphasizes that preanesthetic checking of the ETT cuff is very important.
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Case Reports
Carotid Endarterectomy in a Patient With Type 2 Myocardial Infarction During Preparation for Surgery: A Case Report.
We present a patient who was admitted for carotid endarterectomy due to tight carotid stenosis and recent amaurosis fugax. His medical history included significant coronary artery disease with stable angina pectoris, hypertension with wide pulse pressure, chronic renal failure, and anemia. ⋯ The patient posed a serious clinical dilemma whether to continue with surgery despite the type 2 myocardial infarction or postpone the surgery. We discuss the diagnostic tests and the decision-making processes that guided us in the preoperative period.
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Spontaneous coronary artery disease is an uncommon and likely underdiagnosed cause of sudden cardiac death affecting typically young and middle-aged women. We report a case of spontaneous coronary artery disease in the postoperative period in a female patient who developed an acute coronary event after gynecologic surgery. The patient was clinically asymptomatic except for mild hemodynamic instability and ST-segment-elevation myocardial infarction seen on electrocardiogram. Spontaneous coronary artery disease was diagnosed with coronary angiography, and a pharmacological therapy was instituted with favorable results.