Journal of clinical anesthesia
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Randomized Controlled Trial Comparative Study Clinical Trial
Cardiovascular changes after extraglottic airway insertion: a prospective, randomized comparison between the laryngeal mask or the new PAXpress.
To compare hemodynamic responses induced with the new extraglottic airway, PAXpress, and the classic Laryngeal Mask Airway (LMA). ⋯ Although further studies are required to evaluate safety and airway trauma of this new extraglottic airway, placing the PAXpress produces more marked changes in hemodynamic variables as compared with those produced by the LMA.
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We describe a 67-year-old woman with cholangiocarcinoma who was scheduled for cholecystectomy, trisegmentectomy, bile duct resection, and regional lymphadenectomy. Her case was complicated by hyperlactatemia, sepsis, and multiorgan failure. The discussion reviews the possible causes of the hyperlactatemia and reviews measures that could be used to reduce this risk.
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Case Reports
Spinal epidural hematoma occurrence in the absence of known risk factors: a case series.
Spinal epidural hematoma in the absence of coagulopathy or anticoagulation therapy is an extremely rare occurrence, with a reported incidence of less than 1 in 1 million. We present seven cases of documented epidural hematoma in the absence of coagulopathy or anticoagulation therapy to alert the clinician to consider spinal or epidural hematoma when suspicious signs and symptoms are present after neuraxial block in the absence of coagulopathy or anticoagulation therapy. The need for immediate diagnosis and therapy is emphasized as the only potential for meaningful recovery.
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Spontaneous spinal epidural hematoma is a rare occurrence during pregnancy with only five cases described in the literature since 1900. Even in the general population, the frequency of spontaneous spinal epidural hematoma is extremely low and the etiology unclear. Several theories exist for the cause of spontaneous spinal epidural hematoma, however, none has gained uniform acceptance. ⋯ We hypothesize that the cause of spontaneous spinal epidural hematoma is multifactorial, and pregnancy-induced structural changes in arterial walls and hemodynamic changes may play a role. In addition, we postulate that the origin of the bleeding is arterial, rather then venous. Lastly, the symptoms, diagnosis, and management of spontaneous spinal epidural hematoma during pregnancy are discussed.
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Case Reports
Spinal epidural hematoma following central neuraxial blockade and subcutaneous enoxaparin: a case report.
An elderly patient developed a spinal epidural hematoma 3 days after lumbar puncture resulting in paraplegia. Concurrent administration of enoxaparin, aspirin, ketorolac, and a traumatic tap were implicated in causation.