A&A practice
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Case Reports
Persistent Postoperative Vasoplegia After Ureteronephrectomy Due To Suspected Intravesical Gemcitabine Toxicity.
We describe a case of unusually persistent vasoplegia in the postoperative course of a patient recovering after elective right robotic nephroureterectomy with intravesical salvage gemcitabine. In the treatment of patients with intravesical adjuvant therapy, gemcitabine may precipitate persistent vasoplegia requiring further fluid resuscitative efforts, vasopressor support, and other supportive management. This potential adverse event should be considered when all common causes of persistent vasoplegia are ruled out, such as shock related to bleeding, infection, allergic reaction, or pulmonary embolic phenomenon.
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Review Case Reports
Facial Petechiae Following Laparoscopic Surgery: A Case Report of Rumpel-Leede Phenomenon.
Petechial development as a result of venous compression has variously been described as acute dermal capillary rupture, mask phenomenon, and Rumpel-Leede Phenomenon. We describe the case of a patient who developed a facial petechial rash following a laparoscopic abdominal hysterectomy in steep Trendelenburg position. ⋯ These physiological effects lead to cephalad venous compression and are analogous to the venous compression caused by a tourniquet. The circumstances preceding its development and the characteristics of the facial rash lead us to conclude that the patient we present developed facial Rumple-Leede Phenomenon.
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Case Reports
Hyperventilation and Respiratory Alkalosis After Olanzapine for Insomnia: A Case Report.
Olanzapine is increasingly used as a sleep aid in hospitalized patients. Although thought to have less extrapyramidal effects, known side effects include oversedation, arrythmias, and hypotension. ⋯ This led to a second admission to the intensive care unit with invasive interventions including mechanical ventilation and vasopressor support. Caution must be exercised in prescribing antipsychotics for off-label use, especially in a population whose baseline characteristics can affect the pharmacokinetics of second-generation antipsychotics.
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Bain H circuit is an innovatively modified breathing circuit designed for the transportation and resuscitation of patients with coronavirus disease (COVID-19). For this circuit, the Heidbrink valve was replaced with a 15F inlet and 15M/22F outlet adjustable pressure-limiting (APL) valve, and a high-efficiency particulate air filter was placed over the APL outlet valve. ⋯ All benefits of the conventional Bain circuit were retained. Besides its use in dedicated COVID-19 areas, this circuit can be used in other emergency units of the hospital.
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Increasing medical student enrollment creates challenges for clinical course directors to accommodate students and to provide consistency in clinical experiences. We discuss curricular modifications addressing these challenges specific to anesthesiology electives through the creation of 2-week anesthesiology electives to provide scheduling flexibility in the clinical years. We also incorporated curricular enhancements as a consistent didactic framework congruent with the clinical experience. ⋯ More fourth-year students have enrolled in these courses. The annual number of students matching anesthesiology has maintained ≥8% graduating class. Our highest has been 15% in 2020.