A&A practice
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There has been a significant shift away from epidural analgesia after radical cystectomy within an enhanced recovery program. Alternative techniques reported including continuous erector spinae plane analgesia require supplemental systemic morphine. ⋯ Median length of hospital stay was reduced by a third. The novel analgesic regimen may have the potential to enhance recovery after open radical cystectomy.
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We describe the cases of 2 patients free from mechanical ventilation after a cardiac surgery with systemic venous congestion from right ventricular (RV) failure. Management of these patients included RV preload reduction with diuretics and RV afterload reduction with inhaled pulmonary vasodilators. Noninvasive combination of inhaled epoprostenol and inhaled milrinone through the AirLife filtered nebulizer system (CareFusion) was used. Reduction of splanchnic venous congestion was assessed by Doppler portal flow pulsatility.
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Case Reports
Not Your Typical Dyspnea of Pregnancy: A Case Report of Transcatheter Valve-in-Valve Replacement During Pregnancy.
Because technology for valvular replacement continues to evolve, we expect it to be further reaching in the applications for intermediate- to high-risk surgical candidates. Although the patient population for transcatheter aortic valve replacement has widened, it is still extremely rare in the pregnant patient. ⋯ The patient experienced an excellent outcome after comprehensive coordination across multiple services. We discuss anesthetic considerations in the care of the pregnant patient for transcatheter aortic valve implantation.
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Case Reports
Complete Nephrogenic Diabetes Insipidus After Prolonged Sevoflurane Sedation: A Case Report About 3 Cases.
Volatile anesthetic agents, such as sevoflurane, are increasingly used for long-term sedation in intensive care units worldwide, with improved clinical outcomes reported in recent studies due to favorable pharmacological properties. Despite possible renal toxicity related to the production of plasma inorganic fluoride and concerns related to reversible impairment of renal concentrating abilities, renal injury associated with sevoflurane sedation has rarely been reported in the intensive care unit setting. We hereby report 3 cases of nephrogenic diabetes insipidus associated with prolonged sevoflurane sedation using the AnaConDa device and review the possible mechanisms of renal toxicity.