A&A practice
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Primary leiomyosarcomas of the inferior vena cava (IVC) are rare sarcomas, none of which have been described in literature during a third-trimester pregnancy. Here, we describe the complex care of a patient at 30 weeks of gestation who presented to her obstetrician with shortness of breath and lower extremity swelling. She was found to have a 5.0 × 5.0 × 13 cm heterogeneous mass of her IVC, ultimately diagnosed as a leiomyosarcoma. She underwent a cesarean delivery under combined spinal epidural and a subsequent tumor resection and IVC reconstruction requiring multidisciplinary surgical and anesthetic care.
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Case Reports
Chest Wall Regional Anesthesia for Modified Radical Mastectomy and Axillary Lymph Node Dissection: A Case Report.
Restrictive chest wall disorders impair cardiopulmonary physiology and pose anesthesia-related safety challenges. Regional anesthesia, as the primary anesthetic modality, may mitigate general anesthesia-related risks in such patients presenting for breast cancer surgery. We describe the use of chest wall fascial plane blocks as the primary anesthetic, combined with high-flow humidified nasal oxygen and low-dose propofol sedation, in a patient with complex comorbidities presenting for modified radical mastectomy and axillary lymph node dissection.
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Case Reports
Pregnancy With Large Arteriovenous Malformation of Tongue: Anesthetic Challenges and Conduct.
A pregnant woman with large intraoral arteriovenous malformation of tongue obliterating the oral cavity presented for elective cesarean delivery shortly after experiencing spontaneous, large-volume, oral bleeding. This case report describes the unconventional method of securing the airway for ensuring perioperative airway protection and the anesthetic management of the case.
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Case Reports
Mouthpiece Noninvasive Ventilation in a Patient With Traumatic Cervical Spinal Cord Injury: A Case Report.
The use of noninvasive ventilation (NIV) has been associated with improved patient satisfaction and comfort compared to tracheostomy in patients who are ventilator dependent. We present a case of a young man who fell off a platform and sustained a traumatic third and fourth cervical vertebrae (C3/4) fracture dislocation with bilateral facet dislocation, in whom a trial of mouthpiece NIV was attempted. We discuss the issues surrounding this method of ventilation in ventilator-dependent patients.
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Approximately 15% of patients with a code status of do-not-resuscitate (DNR) or do-not-intubate (DNI) present for surgery. Despite professional guidelines requiring discussions with patients regarding perioperative resuscitation, it is unclear whether these recommendations are consistently followed. Our review of 158 patient encounters with established DNR/DNI code status found that code status discussions (CSDs) were documented only 70% of the time, and code status orders were inconsistently entered to reflect those discussions. We present solutions to improve CSD documentation, including refining perioperative workflows, simplifying code status choices, optimizing electronic health record order entry, and a supplementary consent form to facilitate code status review.