AANA journal
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Case Reports
Elective laparoscopic fetal laser photocoagulation in twin-twin transfusion syndrome: a case report.
Twin-twin transfusion syndrome (TTTS) is a complication of multiple gestation in which arteriovenous vascular communications occur in a shared placenta. Due to these communications, there is an imbalance of blood flow between the developing fetuses. This results in 1 twin becoming the donor and the other becoming the recipient. ⋯ Therapeutic options available include decompression amniocentesis, amniotic septostomy, interruption of the placental vessel communications, and selective fetal reduction. Selective fetoscopic laser photocoagulation of abnormal vascular communications has shown to result in increasing survival rates and has become a definitive treatment option for severe TTTS. The case report presented involves a 32-year-old, gravida 5, para 2 patient at 19 weeks' estimated gestational age with a monochorionic diamniotic twin gestation with TTS diagnosed using ultrasonography presenting for an elective laparoscopic fetal laser photocoagulation.
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Review Case Reports
Methylene blue encephalopathy: a case report and review of published cases.
Methylene blue is a cationic thiazine dye useful in staining parathyroid glands during surgical resection. There have been a number of reports of altered neurologic status postoperatively in patients who are taking antidepressant medications when they received methylene blue for their surgery. ⋯ It has been suggested that in susceptible individuals an interaction occurs between methylene blue and serotonergic agents that precipitates serotonin syndrome. Because people with hyperparathyroidism commonly experience depression as part of their illness, anesthesia practitioners should exercise increased vigilance when administering methylene blue to these patients.
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This course explores the considerations that the anesthesia provider has to be aware of, when caring for a patient with a mitochondrial myopathy. Even though these disorders are rare, these patients may also need surgical care, requiring that the anesthesia provider be informed of the best anesthesia options to consider. A narrative review of documented cases and their outcomes is used to generate a resource of current opinions in the anesthetic care of this patient population.
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General anesthesia is known to cause pulmonary atelectasis; in turn, atelectasis increases shunt, decreases compliance, and may lead to perioperative hypoxemia. One mechanism for the formation of atelectasis intraoperatively is ventilation with 100% oxygen. The goal of this review is to determine if research suggests that intraoperative ventilation with 100% oxygen leads to clinically significant pulmonary side effects. ⋯ From this body of research, it appears that absorption atelectasis does occur in healthy anesthetized adults breathing 100% oxygen. Data reviewed suggest that absorption atelectasis does not have significant clinical implications in healthy adults. However, further research is warranted in populations at increased risk of postoperative hypoxemia, including obese or elderly patients and those with preexisting cardiopulmonary disease.
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Review Case Reports
Preoperative chlorhexidine anaphylaxis in a patient scheduled for coronary artery bypass graft: a case report.
Chlorhexidine is a synthetic antiseptic and disinfectant that has been widely used in the healthcare setting and in everyday household products. In addition to oral rinses and skin preparations, manufacturers have incorporated chlorhexidine coatings into medical devices such as urinary catheters, endotracheal tubes, and central venous catheters in an effort to reduce infection rates. Despite the ubiquitous use of chlorhexidine, severe reactions, such as anaphylaxis, are relatively rare. ⋯ To our knowledge, this is the first reported perioperative anaphylactic reaction to chlorhexidine in the United States. A review of the anaphylaxis cascade, the prevalence of hospital-acquired infections, and the risks of using chlorhexidine are thoroughly discussed. It must be appreciated that life-threatening reactions to this commonly used agent are more than just a theoretical possibility.