A&A practice
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Acute fatty liver of pregnancy is one of the most common causes of fulminant hepatic failure. A 28-year-old G3P1L1A1 presented at 37 weeks with diagnosis of acute fatty liver of pregnancy with grade 3 hepatic encephalopathy. ⋯ We applied these blocks, supplemented with intravenous ketamine for breakthrough visceral pain, to conduct cesarean delivery with a favorable outcome. Thus, transversus abdominis plane with ilioinguinal-iliohypogastric is a viable alternative in patients where general and neuraxial anesthesia is unsafe.
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Case Reports
Early Massive Pulmonary Embolism After Total Hip Arthroplasty in a Patient With Behcet Disease: A Case Report.
Venous complications in Behcet disease (BD) affect nearly 40% of patients. We describe a woman with BD who presented with a massive bilateral pulmonary embolism 30 hours after total hip arthroplasty. The patient underwent surgical thrombectomy and venoarterial extracorporeal membrane oxygenation. ⋯ Therefore, continuation of methotrexate perioperatively should be considered in patients with BD. Systematically performing preoperative deep vein thrombosis screening should be also considered. The patient also had diabetes mellitus treated with metformin and sitagliptin preoperatively.
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Regional anesthetic blocks, especially in-dwelling catheters, are infrequently used in neonates and infants. The following report describes a neonate with a gangrenous right upper extremity requiring multiple painful debridements over several weeks. ⋯ After the initial procedures, bolus doses of a local anesthetic agent provided surgical anesthesia for dressing changes, thus obviating the need for multiple general anesthetics. This case demonstrates the potential efficacy of regional techniques to both treat pain and limit anesthetic exposures in neonates.
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An ultrasound-guided thoracic paravertebral nerve block was administered for left-sided abdominal pain. Lidocaine 0.4% (9.5 mL) was injected. ⋯ It was postulated that the local anesthetic was injected into the cyst, which communicated with the subarachnoid space. This case report demonstrates the anatomic variations of nerve root sheath cyst sites and the risk of injection into intranerve root sheath cysts during interventional procedures.
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Case Reports
Never Say Never: The Use of Nitric Oxide in Patients With Obstructed Pulmonary Veins: A Case Report.
Pulmonary vein stenosis (PVS) is a progressive disease with pulmonary hypertension (PH) as a major cause of morbidity and mortality. Traditional management of PH with inhaled nitric oxide (iNO) is typically avoided in PVS patients because, while iNO may reduce pulmonary vascular resistance, PH persists as pulmonary blood flow increases in the presence of a downstream resistive lesion. We report 3 cases with primary PVS and PH in which iNO was used to successfully decrease mean pulmonary artery pressures with clinical improvement. Based on this experience, we suggest that iNO can be used to treat PH in select patients with PVS.