A & A case reports
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Case Reports
Perimortem cesarean delivery in a pregnant patient with goiter, preeclampsia, and morbid obesity.
Cardiopulmonary arrest during pregnancy is a devastating event necessitating rapid intervention from experienced practitioners to reduce the incidence and severity of adverse maternal and fetal outcomes. Perimortem cesarean delivery is rarely performed within the recommended time frame to meet these goals. We describe a case of a successful perimortem cesarean delivery after the "4-minute rule" in a morbidly obese parturient with goiter and preeclampsia.
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Case Reports
Anesthesia considerations for cesarean delivery in a patient with Loeys-Dietz syndrome.
A 28-year-old primigravida female with Loeys-Dietz syndrome presented at 36 weeks' gestation for scheduled primary elective cesarean delivery. The patient had clinical findings consistent with this diagnosis, including mild aortic root dilation, chronic right vertebral artery dissection with 2 intracerebral aneurysms, and small ectasias of the thecal sac in the lumbar region. Pregnant patients with Loeys-Dietz syndrome have significant risks, including aneurysm rupture, new aneurysm formation, and uterine rupture. After a thorough preoperative evaluation, the patient underwent successful general anesthesia focused on maintenance of intraoperative hemodynamic stability and minimal intraoperative blood loss.
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Case Reports
Postoperative oxycodone toxicity in a patient with chronic pain and end-stage renal disease.
We present this case to review the metabolism of oxycodone and the effects of end-stage renal disease on the elimination of oxycodone and its metabolites. A 42-year-old female with end-stage renal disease who was dependent on hemodialysis presented for left hamstring posterior capsule release. She had been receiving methadone for 2 years for chronic leg pain. ⋯ By the next day, the patient was unarousable with notable respiratory depression. She did not fully recover after urgent hemodialysis but did have full recovery after receiving an IV naloxone infusion for 22 hours. Further study of the safety of oxycodone in hemodialysis patients is warranted.
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An ultrasound-guided thoracic paravertebral catheter was placed at T8 in a 15-year-old girl with cystic fibrosis and right-sided chest pain from avulsion of the eighth rib, secondary to coughing. She was discharged home after respiratory stabilization and returned to school with the catheter in place. We report the effective use of an ultrasound-guided continuous thoracic paravertebral block in the management of acute rib pain in a pediatric patient with cystic fibrosis.
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A 3-year-old male with isovaleric acidemia presented for dental rehabilitation under general anesthesia. In times of stress, such as in the perioperative period, patients with isovaleric acidemia are at greater risk for morbidity and mortality from disordered metabolism, including glucose disturbances, hyperammonemia, hypocalcemia, and non-anion gap metabolic acidosis. Communication between the anesthesiology, dental, and endocrine teams allowed for safe and successful care of the patient.