Journal of clinical anesthesia
-
Due to the risks of transfusion reactions and the transmission of infectious diseases, there has been increased interest in measures to limit intraoperative blood loss and avoid the need for homologous transfusion. Controlled hypotension is one technique that has been used to limit intraoperative blood loss. Several drugs have been used alone or in combination for controlled hypotension, including the inhalational anesthetics, direct acting vasodilators such as nitroglycerin and nitroprusside, beta adrenergic antagonists, and calcium channel blockers. Various drugs available to the clinician for controlled hypotension are reviewed.
-
Cardiopulmonary bypass (CPB) does not appear to cause excessive maternal risk, but the potential for fetal complications is of great concern. In general, operative intervention should be delayed until at least the second trimester. ⋯ This conflict is further complicated by maternal status changes that may accompany valvular disease or develop after CPB. The case described herein summarizes and discusses these conflicts.
-
Hyskon, a distension medium composed of dextran 70 in 10% dextrose in water, is often used during hysteroscopic procedures. Coagulopathy and pulmonary edema are the most commonly reported side effects encountered during its use. We present the first case report in which a healthy patient developed pulmonary hemorrhage from Hyskon use. The major side effects of Hyskon are discussed, as are the possible etiologies of the reported complication and the implications for anesthesiologists.
-
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.
-
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.