AANA journal
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This report describes the noncardiac, nonobstetric surgical case of a 29-year old woman with idiopathic pulmonary arterial hypertension. To safely manage a patient with pulmonary hypertension, the anesthesia provider must have a thorough understanding of the disease and associated risks. This case study briefly summarizes the surgical case and then discusses history, current classifications, epidemiology, pathophysiology, contemporary treatments, and basic anesthetic management related to pulmonary hypertension.
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With the advancement of medicine, surgery, and technology, along with the decline in mortality, anesthesia providers encounter patients with complex and rare conditions. One such example is the single ventricle congenital cardiac defect, which is corrected with Fontan reconstructive surgery. ⋯ The case report describes a parturient who, approximately 2 decades earlier, had undergone a Fontan operation at the age of 4 years and recovered uneventfully. This article discusses the anesthetic management for the patient during cesarean delivery using epidural anesthesia, and the minimally invasive monitoring technology (Vigileo monitor, Edwards Lifesciences) to assist in monitoring the patient intraoperatively.
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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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Emergence agitation or delirium is a known phenomenon in the postanesthesia period. The underlying cause is not definitively understood. In a U. ⋯ The authors conclude that best practice includes a proper identification of patients at risk of emergence agitation, a minimally stimulating environment, intraoperative sympatholytic therapy, and patient and staff education. Although the case studies presented support these principles, research is needed to provide stronger evidence. Military medical and research personnel can take the lead on this issue and be a source for improved outcomes and high-quality patient care.