A&A practice
-
Case Reports
Cerebral Oximetry Fails as a Monitor of Brain Perfusion in Cardiac Surgery: A Case Report.
Cerebral oximetry is commonly being advocated as a monitor for regional cerebral tissue oxygenation during cardiac surgery. We have increasing concern about the accuracy of this monitor, including the current systems entering the market, with new probes and algorithms. ⋯ In the current form, cerebral oximetry may at best be an expensive tool without any benefit on outcomes. In addition, it may contribute to misleading and confusing clinical data.
-
Dexamethasone is widely used in current practice for the prevention of postoperative nausea and vomiting. Although its use in the perioperative setting has been associated with several side effects (eg, hyperglycemia and suppression of adrenal cortisol production), their clinical significance remains questionable. We present the case of a healthy 27-year-old woman who developed acute adrenal insufficiency after receiving intraoperative dexamethasone for postoperative nausea and vomiting prophylaxis during a laparoscopic left oophorectomy.
-
Case Reports
Clinical Cyanosis in a Patient Presenting for Outpatient Colonoscopy: A Case Report of Hemoglobin Kansas.
Gene mutations that affect the synthesis or structure of hemoglobin are present in 7% of the world's population. These mutations lead to variant hemoglobinopathies with phenotypes that range from clinically insignificant to fatal. Because monitoring oxygen saturation is standard of care and critical to detecting hypoxemia, it is crucial to recognize factors that might interfere with the measurement of oxygen saturation or decrease oxygen delivery. We discuss the management of a patient who presented to a freestanding surgical center with the rare variant hemoglobin Kansas, clinical cyanosis, and an initial pulse oximetry reading of 68% on room air.
-
Case Reports
Epidural Anesthesia for Cesarean Delivery in A Parturient With Lumboperitoneal Shunt: A Case Report.
A lumboperitoneal shunt facilitates dynamic flow of cerebrospinal fluid into the peritoneum. Consequently, neuraxial technique placement in the parturient with a lumboperitoneal shunt can result in unexpected levels of blockade. We present the case of a parturient with a lumboperitoneal shunt who experienced symptoms consistent with high blockade after epidural administration of 450 mg chloroprocaine. This report emphasizes potential mechanisms for high neuraxial blockade and strategies to decrease risks in this unique patient population.
-
Tracheomalacia is characterized by the collapse of the tracheal wall due to the softening of the tracheal cartilage and myoelastic tissues. We describe the case of a 12-year-old morbidly obese boy, without previous medical issues, scheduled for elective laparoscopic cholecystectomy. ⋯ Intraoperative exploration with flexible bronchoscopy showed that the tip of the endotracheal tube was nearly occluded by the posterior tracheal wall bulging anteriorly. Anesthesiologists should be aware of undiagnosed tracheomalacia as a cause of sudden airway collapse, even after the airway is secured with an endotracheal tube.