A&A practice
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A patient with a base of tongue tumor was judged to be safe to intubate under general anesthesia, with a new flexible tip "bougie." This enabled rapid and easy navigation around the distorted anatomy caused by the tumor. The bougie's tip can be flexed or extended by activating a slide on the shaft and was intended for use with the hyperangulated blade of a videolaryngoscope.
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Congenital hernias, frequently misdiagnosed during pregnancy, are potentially fatal and require prompt repair. A pregnant woman with medical history of repaired congenital hernia was admitted with misdiagnosis of preeclampsia. Physical examination and chest x-ray revealed a Bochdalek hernia. ⋯ A multidisciplinary team was present in the operating room. All monitoring catheters were placed in advance in the intensive care unit. During recovery, the patient experienced ventricular fibrillation, presumed to be a manifestation of takotsubo syndrome, which responded favorably to cardiopulmonary resuscitation.
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Pericarditis is a source of chest pain that can be chronic and debilitating. We describe a patient diagnosed with pericarditis with chest pain refractory to medical management. ⋯ Possible reasons for this result may include incomplete transection, a significant contribution of pain signaling from the phrenic and/or vagus nerve, or nerve regeneration. Literature describing these interventional techniques for pericardial pain is sparse, and more research is needed to determine their efficacy in refractory pericardial pain.
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Extracorporeal membrane oxygenation is a rescue treatment for respiratory or cardiac failure. Its use is limited in patients predisposed to bleeding due to heparin administration. We present 2 patients with deranged coagulation after liver rupture successfully treated by extracorporeal membrane oxygenation. ⋯ Liver segments VI and VII were resected. Endovascular aneurysm repair of aortic dissection and venoarterial extracorporeal membrane oxygenation were performed. Both patients survived without neurological sequelae.
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Case Reports
Anesthetic Considerations in Saul-Wilson Syndrome, a Rare Skeletal Dysplasia: A Case Report.
Saul-Wilson syndrome, also known as microcephalic osteodysplastic dysplasia, is a rare type of dwarfism with significant anesthetic considerations. The genetic defect is associated with nearly uniform micrognathia, odontoid hypoplasia, and possible cervical spine instability that contribute to potentially increased risk of airway complications. Herein, we describe the anesthetic management of a 2-year-old child with Saul-Wilson syndrome.