A&A practice
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A 52-year-old patient was scheduled for a cystoscopy. Anesthesia was induced by intravenous injection of fentanyl and propofol. After administration of atracurium, he became bradycardic and suffered a cardiac arrest. ⋯ The postmortem found no pathology. However, mast cell tryptase was raised significantly, indicating fatal anaphylaxis. Having presented no classic clinical signs, this case is a reminder that rapid cardiovascular collapse can be the sole clinical feature of anaphylaxis.
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Dexmedetomidine is a selective α2-agonist, frequently used in perioperative medicine as anesthesia adjunct. The medication carries a Food and Drug Administration pregnancy category C designation and is therefore rarely used for parturients undergoing nonobstetric surgery. We are reporting the use of dexmedetomidine in the anesthetic management of a parturient undergoing minimally invasive unilateral adrenalectomy for pheochromocytoma during the second trimester of pregnancy. Additionally, because of the multiple endocrine neoplasia type 2A constellation with diagnosis of medullary thyroid cancer, the patient underwent a total thyroidectomy 1 week after the adrenalectomy.
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Blunt chest trauma and the treatment of associated pain can lead to impaired respiratory drive and abnormal pulmonary mechanics, in turn resulting in significant respiratory system complications. These can include pneumonia, hypoxia, atelectasis, and a prolonged need for invasive mechanical ventilation. ⋯ However, this treatment modality also carries a small risk of severe neurological complications such as spinal cord trauma, spinal cord ischemia, and epidural hematoma or abscess. This case report describes one such rare neurological complication: acute quadriparesis after thoracic epidural placement.
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Upper airway obstruction during anesthesia is the leading cause of complications during sedation, intubation, and emergence. Devices to support oxygenation and ventilation are costly, require capital equipment, and cannot be used during transport. ⋯ The SuperNO2VA nasal mask provided high-flow nasal oxygen and positive pressure during awake fiberoptic intubation and on extubation, maintaining airway patency in the operating room, during transport, and in recovery. The SuperNO2VA is inexpensive and portable and should be considered for high-risk patients with difficult airways.
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Case Reports
Mitral Valve Compression Induced Hypoxemia After Left Ventricular Assist Device Surgery: A Case Report.
Blood flow obstruction of left ventricular assist device (LVAD) is not uncommon. Causes of flow obstructions could be prepump, intrapump, and postpump. Clinical and echocardiographic parameters of LVAD obstruction vary substantially, ranging from being completely asymptomatic with unchanged functional status, normal filling pressures to frank cardiogenic shock. In the current case report, we present hypoxemia as an early presentation of LVAD inflow obstruction in the early postimplantation period in the absence of respiratory cause for hypoxemia.