Journal of clinical anesthesia
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The successful management of major conduction anesthesia in a patient with Klippel-Trenaunay syndrome is discussed. This case illustrates that major conduction anesthesia can be safely used if proper imaging studies are obtained, if one is aware of the underlying disease process, and if there is no port wine lesion in the dermatomal area corresponding to the spinal segment where the needle is to be inserted.
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Case Reports
Cesarean section in a pregnant patient with an anterior mediastinal mass and failed supradiaphragmatic irradiation.
Nodular sclerosing Hodgkin's disease stages IA and IIA are the most common presentation of this disease during pregnancy. Patients presenting with late Hodgkin's disease with failed irradiation for cesarean section present a unique challenge. ⋯ We report a case involving a pregnant patient at 34 weeks' gestation presenting for cesarean section with a symptomatic anterior mediastinal mass occupying over 50% of the thoracic diameter. The anesthetic management was performed using continuous spinal.
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Arterial misplacement of the Swan-Ganz catheter occurs occasionally and usually can be easily detected. However, in some special clinical settings, the problem may become more complicated. We report a case of chronic obstructive pulmonary disease in which, because of severe hypoxemia, systemic hypotension, and pulmonary hypertension, conventional methods failed to recognize the misplacement, until confirmed with blood gas analysis.