A&A practice
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We present a case of acute dyspnea due to postoperative oral bleeding after tonsillectomy, wherein a blood clot obscured the laryngeal structures to such an extent that no recognizable structures could be identified. A larger-bore suction catheter without side holes proved necessary to solve the problem. The case illustrates how a gradually forming blood clot can remain asymptomatic until reaching a size where it poses an airway threat and highlights the necessity for readily available larger-bore suction devices without side holes. We consider this as an important reminder of the unpredictable nature of blood clot formation and its management.
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Case Reports
Diagnostic Ultrasound: On-Site Diagnosis of Type B Aortic Dissection During Cataract Surgery.
We report a case of aortic dissection occurring during cataract surgery under local anesthesia, which was diagnosed on-site by point-of-care ultrasound. Intimal flaps were detected in the abdominal aorta, whereas the parasternal view showed no abnormalities in the aortic root or left ventricular function. ⋯ Subsequent computed tomography (CT) confirmed the point-of-care diagnosis. The patient was transferred to a tertiary hospital for medical treatment.
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Case Reports
Diagnostic and Therapeutic Ilioinguinal and Iliohypogastric Nerve Blocks: A Case Report.
We present a case report of a consult for a gynecologic patient who presented with unrelenting postsurgical pain and previously underwent laparoscopic surgery. Given the pain distribution, we hypothesized the patient had an ilioinguinal or iliohypogastric nerve entrapment injury. ⋯ The patient returned to the operating room to release a fascial stitch, permanently relieving the pain. This is a reminder that anesthesiologists can use regional anesthesia for both diagnosis and treatment.
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Case Reports
Wireless Interrogation During Cardiac Surgery For a Patient With Aveir Leadless Pacemaker: A Case Report.
Intraoperative wireless interrogation is a useful monitoring method for the leadless pacemaker (LP); however, there are few reports on this technique. A 60-year-old woman underwent cardiac surgery 24 days after Aveir LP implantation. Considering the risk of intraoperative device dislodgment and pacemaker malfunction due to electromagnetic interference, the LP was monitored by wireless interrogation via body-surface electrodes, and no device dislodgement or pacemaker malfunction was observed during surgery. Our findings suggest that wireless interrogation using body-surface electrodes on the chest is a practical and valuable monitoring technique in open-heart surgery, which lends additional safety to anesthetic management.
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Case Reports
Three Episodes of Postanesthesia Paradoxical Vocal Cord Motion Disorder in the Same Patient: A Case Report.
Postanesthesia paradoxical vocal cord motion disorder (PVCMD) is often benign. However, if not recognized, PVCMD can lead to unnecessary treatments. Our patient had 3 different surgeries over a period of 20 months. ⋯ The third episode of PVCMD occurred after a cervical fusion surgery. Prevertebral edema from surgery further compromised the airways. Our case demonstrates the challenges of identifying and managing perioperative PVCMD, especially when surgical complications confound the airway management.