A & A case reports
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Acute disruption of venous return during cardiopulmonary bypass (CPB) may be due to malposition of the venous cannula, kinks or obstruction of the venous tubing by a smaller cannula, airlock, or mechanical disruption of blood flow. We describe an acute obstruction of the venous cannula by blood clots that were visualized on the transesophageal echocardiogram during CPB. Appropriate measures were taken by the surgeon to evacuate the clot and restore CPB. The clots were not seen on the transesophageal echocardiogram before CPB raising suspicion that they originated in a lower extremity and migrated to the right atrium resulting in venous cannula obstruction.
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The anesthetic implications of acute leukemia in pregnancy have not been reported. We describe the anesthetic management of a laboring primigravida at 34 weeks' gestation with new-onset acute myeloid leukemia. With multidisciplinary consultation, we recommend that neuraxial anesthesia be avoided in new-onset acute myeloid leukemia due to the risk of introducing malignant cells into the central nervous system, which can spread the disease and complicate management. We discuss the use of a fentanyl patient-controlled analgesia and dexmedetomidine as a method of labor analgesia, and the potential benefits of the latter medication in the obstetric population.
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Thyroid storm, a severe complication of hyperthyroidism, can be a devastating medical emergency requiring rapid management. Intraoperative thyrotoxicosis, a hypermetabolic syndrome with increased thyroid hormone levels, also presents a challenging scenario. ⋯ In this case report, we describe a 15-year-old male undergoing halo traction placement for displaced dens and C1 fractures. Preoperative tachycardia and a history suggestive of hyperthyroidism raised our clinical suspicion for thyrotoxicosis when hypertension and tachycardia developed after induction of anesthesia.
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The reported adverse effects of perioperative transesophageal echocardiography (TEE) are mostly associated with the insertion and manipulation of the TEE probe. Recent data suggest that blind probe insertion may be associated with greater morbidity than reported previously. ⋯ Herein, we present a novel insertion technique using a soft-tipped esophageal bougie as a guide for blind TEE probe insertion in a patient undergoing cardiac surgery. The potential advantages and related safety issues are discussed.