A&A practice
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In this case report, we describe 2 patients with septic shock requiring high-dose vasopressors for hemodynamic support despite aggressive fluid resuscitation. After the administration of high-dose hydroxocobalamin for presumed septic vasoplegic syndrome, both patients had an immediate response to hydroxocobalamin with a rapid and lasting improvement of blood pressure that significantly reduced the need for vasopressor support.
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Case Reports
Airway Compression During Transcatheter Aortic Valve Replacement Via Subclavian Artery Approach: A Case Report.
Transcatheter aortic valve replacement (TAVR) is an alternative to traditional surgery in patients considered to be at high or intermediate risk for open surgical repair of aortic stenosis. Despite its overall safety and efficacy, TAVR is associated with potentially serious complications including major vascular injury. Tracheal compression resulting from vascular pathology has been previously reported; however, airway compromise secondary to vascular injury during TAVR has not been described. We report a case of airway compression and respiratory compromise resulting from injury to the right subclavian artery during TAVR.
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Case Reports
A Novel Tool to Guide Reintegration of Anesthesiologists Into Clinical and Academic Work After Concussion.
Concussion is a common form of mild traumatic brain injury that can cause somatic, cognitive, and behavioral impairments lasting days to weeks. There are no published guidelines or recommendations to facilitate the safe and successful reintegration of anesthesiologist clinicians and trainees into clinical and academic work after concussion. We developed a simple 4-phase postconcussion recovery protocol for anesthesiologists who have suffered concussion and describe the successful use of this postconcussion recovery protocol to support reintegration of an Anesthesiology Critical Care Medicine fellow who developed mild concussion during vacation leave.
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Case Reports
Toxic Ingestion of Acetaminophen and Acetylsalicylic Acid in a Parturient at 33 Weeks Gestation: A Case Report.
The anesthetic management of toxic ingestion during pregnancy requires concomitant concerns for both mother and fetus. We describe the management of a parturient at 33 weeks of gestation after a suicide attempt by ingestion of acetaminophen (APAP) and acetylsalicylic acid (ASA). ⋯ Fetal exposure to toxins must also be minimized. The use of point-of-care rotational thromboelastometry in conjunction with standard coagulation testing in such cases facilitates consideration of neuraxial anesthesia and determination of risk for postpartum hemorrhage.
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Myocardial ischemia postarterial switch operation has been reported extensively in the literature and has been almost exclusively ascribed to issues related to coronary artery translocation. Here, we report a case of a 5-week-old child with D-transposition of the great arteries who underwent an arterial switch operation and developed myocardial ischemia after pericardial drain placement, as evidenced by significant ST segment elevation and abnormal regional cardiac wall motion. The ST segment and cardiac wall motion improved once the drain was withdrawn from the pericardium and placed in the retrosternal space. Few reports in the literature describe this complication, particularly in pediatric patients.