A&A practice
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Case Reports
Hereditary Antithrombin Deficiency: A Balancing Act of Perioperative Hemostasis and Thromboprophylaxis-A Case Report.
Hereditary deficiency of antithrombin (AT) is associated with increased risk of venous thromboembolism (VTE), especially under the circumstances of stress, vascular injury, and immobilization associated with surgery. To date, there is no consensus on the use of perioperative anticoagulant bridging in the setting of hereditary thrombophilia. Balancing hemorrhagic and thrombotic risks associated with anticoagulant bridging and AT deficiency can be challenging to perioperative physicians. We present a case of a 65-year-old woman with inherited AT deficiency with history of multiple VTEs who was admitted for presurgical anticoagulant bridging before microvascular decompression craniotomy for trigeminal neuralgia.
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Case Reports
Right Ventricular Outflow Tract Obstruction in the Intensive Care Unit: A Case Report of 2 Patients.
Right ventricular outflow tract obstruction (RVOTO) is a rare cause of hemodynamic instability in the intensive care unit (ICU) after cardiac surgery. We report the first cases of RVOTO diagnosed in the ICU using continuous right ventricular pressure waveform monitoring. ⋯ Inotrope use can exacerbate RVOTO caused by dynamic etiology, whereas surgery is usually the treatment of choice for mechanical obstructions. Inability to recognize RVOTO or the correct etiology can lead to hemodynamic compromise and poor outcomes.
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Transesophageal echocardiography can be useful not only in diagnosing venous air embolism but also in guiding aspiration of air from the pulmonary artery. A 59-year-old man with a history of cirrhosis underwent combined kidney and liver transplantations. ⋯ Transesophageal echocardiography revealed air in the pulmonary artery resulting in outflow obstruction. Under echocardiographic guidance, the pulmonary arterial catheter was withdrawn to the air pocket and aspirated, resulting in improved hemodynamics and successful completion of transplantations.
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Case Reports
Challenges in Obstetric Anesthesia in a Parturient With Native American Myopathy: A Case Report.
Native American Myopathy (NAM) is an inherited, malignant hyperthermia-susceptible myopathy associated with abnormal craniofacial development and neuromuscular scoliosis. There is scant NAM anesthetic literature and, to our knowledge, no existing publications describing the anesthetic management of a NAM parturient. The constellation of symptoms of NAM in the parturient presents a number of challenges to the obstetric anesthesiologist, including difficult airway associated with craniofacial abnormalities and pregnancy, malignant hyperthermia susceptibility, and possible difficult neuraxial block. In this report, we present the anesthetic management of a parturient with NAM and previous extensive posterior spinal fusion undergoing cesarean delivery under general anesthesia.