Journal of clinical anesthesia
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Repair of a retinal detachment was performed during a retrobulbar block with monitored anesthesia care and intravenous conscious sedation. Following the procedure and after removal of the sterile drapes, the patient exhibited significant swelling of the bilateral orbits, face, neck, and chest. Subcutaneous emphysema and pneumomediastinum were confirmed on postoperative chest radiographs and computed tomographic scans. Possible mechanisms and potential sequelae of this intraoperative event are discussed.
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To evaluate the management of accidental dural puncture (ADP) and postdural puncture headache (PDPH) among obstetric anesthesiologists practicing in North America. ⋯ Protocols for ADP management are rare. There is wide variation in catheter management after dural puncture, measures used to prevent and treat a resultant headache, and EBP management.
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Sheehan's syndrome is a well described entity that refers to hypopituitarism with pituitary infarction secondary to postpartum shock or hemorrhage. Antepartum pituitary infarction is a very rare condition that has been reported only in patients with longstanding type 1 diabetes mellitus or uncontrolled gestational diabetes. A case of severe, acute hypopituitarism in the setting of hemorrhagic shock from a gunshot wound is presented. Our case report highlights the importance of including hypopituitarism in the differential diagnosis of a critically ill parturient.
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Case Reports
Supraglottic jet ventilation assists intubation in a Marfan's syndrome patient with a difficult airway.
A 37 year old woman with Marfan's syndrome underwent an elective gynecologic procedure. Mask ventilation was not difficult but initial direct laryngoscopy showed no view of the glottic opening. ⋯ The technique provided oxygenation and ventilation during intubation and assisted intubation of a patient with a grade III glottic view. No hypoxia or barotrauma were noted during the intubation.