Journal of clinical anesthesia
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There is rapidly increasing prevalence of obesity throughout Western societies and increasing numbers of patients undergoing surgery are obese. Obesity is a condition of chronic systemic inflammation and is associated with an increased burden of comorbidities. Despite traditional teaching, obesity may not be an independent risk factor for poor postoperative outcomes. The Obesity Paradox describes the observation that small amounts of excess body fat may be protective against postoperative complications.
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Case Reports
Fibrodysplasia ossificans progressiva: anesthetic management in complex orthopedic spine procedures.
Fibrodysplasia ossificans progressiva (FOP) is a rare disorder of the connective tissue leading to progressive tissue ossification and immobilization. Soft-tissue trauma may exacerbate this condition, causing further ossification. ⋯ Anesthetic management was complicated by airway, pulmonary, and positioning challenges. Neuromonitoring allowed identification of spinal cord ischemia while avoiding a wake-up test.
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Diaphragmatic herniation is known to create cardiorespiratory challenges for the anesthesiologist. With the increasing use of the transhiatal surgical approach for esophagectomy, the occurrence of transhiatal herniation of bowel is likely to be encountered. A case of circulatory collapse during induction of anesthesia in a patient with transhiatal herniation is presented.
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Case Reports
Intracranial hemorrhage from undiagnosed metastatic brain tumor during general anesthesia.
A patient with endometrial cancer presented with intracranial hemorrhage from an undiagnosed metastatic brain tumor during abdominal radical hysterectomy. Since she was neurologically intact, a systematic examination for brain metastasis had not been performed preoperatively. After the surgery, she had delayed recovery from general anesthesia with right hemiplegia and aphasia. Computed tomography and magnetic resonance imaging showed left putaminal hemorrhage from brain metastasis.