A&A practice
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Autosomal dominant or benign osteopetrosis is a rare genetic disorder of osteoclasts that results in dense but brittle bone structures. Patients with osteopetrosis may be scheduled for total knee arthroplasty to treat painful and functionally limiting osteoarthrosis. A search of the published literature produced no citation concerning anesthesia for patients with autosomal dominant osteopetrosis undergoing total knee arthroplasty. We present a case report detailing our experience and discuss considerations for the care of future patients with autosomal dominant osteopetrosis.
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Case Reports
Exchange Autotransfusion for Rapid Correction of Hyperkalemia During Liver Transplantation: A Case Report.
A 46-year-old woman with alcoholic cirrhosis and hepatorenal syndrome requiring hemodialysis presented with hyperkalemia (5.5 mEq/L) immediately before liver transplantation. For correction of hyperkalemia, an exchange transfusion began by removing her blood into an autotransfusion system to wash out noncellular components while maintaining normovolemia. ⋯ Postreperfusion syndrome was not observed. In summary, exchange transfusion was used successfully for rapid correction of hyperkalemia, showing the value of its application in liver transplantation.
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We report the case of a 60-year-old man who underwent open radical prostatectomy for prostate adenocarcinoma. He had no known cardiac disease or symptoms other than controlled hypertension and remote history of cocaine use. ⋯ Subsequent cardiac workup showed no abnormalities. We believe the cause of arrest was sugammadex, considering the time of administration, the absence of cardiac disease, and stable operative course.
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Gastric ultrasound is emerging as a tool that can be used to assess gastric content and volume in patients with an unknown fasting history. This information can impact the choice of anesthetic technique or the timing of surgery due to the presumed risk of aspiration. Currently, no data are available regarding the use of gastric ultrasound for patients who have had prior gastric operations, despite the increasing number of patients undergoing bariatric surgery. Our experience suggests that a patient with a prior Roux-en-Y gastric bypass may present with altered anatomy, rendering gastric ultrasound an ineffective technique to assess the volume of ingested food or liquid.
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As technology progresses, our clinical treatment options rise steadily. We are comfortable now with the handling of ready-to-use high-quality videolaryngoscopes and fiber optics, and there is increasing knowledge and practice that the combination of these 2 techniques has a high "rescue rate" in situations when fiber-optic intubation or videolaryngoscopic intubation fails. Therefore, we would recommend to specifically include this technique in the "difficult airway algorithm-nonemergency pathway," so it comes routinely into mind when faced with a "can ventilate, but cannot intubate" situation that warrants intubation for the surgical operation.