A&A practice
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Intraoperative cell salvage (ICS) became commercially available in 1968 and has enjoyed wide uptake. However, its use in transurethral resection of prostate (TURP) remains rare. We describe a 71-year-old man who underwent TURP with incomplete blood cross-matching. ⋯ ICS was used to retrieve blood present in bladder irrigation. This is the first Australian report of ICS use during TURP. This case led to a change in our practice and serves to demonstrate the potential of this technology during emergencies.
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Patients who are Jehovah's Witnesses are known to the medical community for frequently declining blood products, even at times of life-threatening anemia. Alternatives to red blood cell transfusion are being developed, including hemoglobin (Hb)-based oxygen carriers. We present the case of a 77-year-old male Jehovah's Witness who underwent a cystoprostatectomy and radical nephrectomy with a postoperative Hb nadir of 4.5 g/dL. He received an Hb-based oxygen carrier, PEGylated carboxyhemoglobin bovine (Sanguinate), with gradual improvement in anemia symptoms and eventual discharge to a short-term rehabilitation facility.
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The role of the anesthesiologist in the perioperative environment requires facility in leadership; however, leadership education is not part of the traditional curriculum for anesthesiology trainees. To address this educational gap, we developed a leadership program for anesthesiology residents at an academic medical center to build competency in the areas of teamwork, emotional intelligence, integrity, selfless service, critical thinking, and patient-centeredness, constructs that correlate with the Accreditation Council for Graduate Medical Education competencies of interpersonal and communication skills and professionalism. This report describes the design and implementation of the program, including the curriculum, and offers recommendations for implementation at other institutions.
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Thoracic outlet compression syndrome is a complex syndrome of neurovascular compression at the superior thoracic aperture, thought to occur at 1 of 3 anatomical compartments: the interscalene triangle, the costoclavicular space, and the retropectoralis minor space. Injection into the middle interscalene muscle (ISM) and/or pectoralis muscle plane (PECS I and II) is gaining popularity because it provides significant symptomatic relief. ⋯ ISM and PECS I and II blocks with botulinum toxin type A were successful. In combination, PECS I/II and ISM injections can provide excellent symptomatic relief.
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The epidural blood patch (EBP) is commonly used to treat postdural puncture headaches (PDPHs) from spinal anesthesia, dural puncture with epidural anesthesia, and diagnostic and therapeutic lumbar puncture. We present a case of a patient with pseudotumor cerebri (idiopathic intracranial hypertension) who had a lumboperitoneal shunt placed for persistent headaches and subsequently developed symptoms similar to a PDPHs that were successfully treated with an EBP. While the exact mechanism by which our patient was experiencing PDPH symptoms is unknown, the EBP administration proved to be both therapeutic and diagnostic by ruling out shunt catheter malfunction through a resolution of symptoms.