A&A practice
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We describe a patient with severe Arnold Chiari Malformation and syringomyelia who underwent gynecological laparoscopy in an emergency context; no brain imaging was available. We here report the successful use of optic nerve sheath diameter (ONSD) and middle cerebral artery (MCA) velocity measurements as surrogate monitoring for cerebral blood flow and intracranial pressure, respectively. MCA velocity was low when assessed after peritoneal insufflation and ONSD increased to 6.3 mm after Trendelenburg positioning. This noninvasive Ultrasound and Doppler neurological monitoring helped adapt the anesthetic management and the patient recovered both normal ONSD and MCA velocity values.
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Transcatheter aortic valve replacement (TAVR) is a common treatment for severe aortic stenosis (AS), but it carries the risk of severe complications, including device embolization. We present a case of a TAVR valve embolization into the left ventricular outflow tract (LVOT), diagnosed with transesophageal echocardiography (TEE) shortly after device deployment. The dislodged valve was successfully retrieved from the LVOT into the aorta, flattened, and stabilized with a thoracic endovascular aneurysm repair (TEVAR) stent, enabling the successful implantation of a new TAVR valve.
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Case Reports
A Nonequipment-Related Line Isolation Monitor Alarm: A Problem-Based Learning Discussion.
A line isolation monitor (LIM) alarm is a device in the operating room to alert personnel to a potential fault in equipment or the electrical system. Typically, an LIM alarm is related to an electrical fault in a piece of operating room equipment. We present a case where the hazard current by the LIM briefly decreased, then continued to climb after unplugging equipment. This report aims to provide clinicians with an understanding of LIMs and an awareness that there are nonequipment causes for an LIM alarm.
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Quadro-iliac plane block (QIPB) is a novel regional anesthesia technique that provides analgesia in the abdominal, lumbar, and hip regions. Case reports about the efficacy of this block in the literature are limited. In this report, we would like to share our successful QIPB experience with a patient with chronic myofascial low back pain.