A & A case reports
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Acute aortic occlusion by massive thoracoabdominal thrombi has been reported as a serious complication in patients undergoing major vascular or cardiac surgical procedures. However, this complication occurs rarely after ambulatory procedures. In this case report, we describe a patient who experienced paraplegia after an elective laparoscopic cholecystectomy in whom acute aortic thromboembolic occlusion was subsequently diagnosed. We emphasize the importance of accurate neurologic and cardiovascular history taking and examination throughout the perioperative period along with the appropriate diagnostic studies to expeditiously arrive at a diagnosis of such a rare complication.
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Patients presenting with alcohol withdrawal syndrome have an increased risk of perioperative events related to hemodynamic and respiratory instability. We present the case of a 49-year-old achondroplastic dwarf in alcohol withdrawal with cervical spinal cord injury and aortic dissection requiring emergency surgery. Due to conflicting perioperative management goals, a decision was made to delay surgery until the patient became clinically stable. Additional options might have been explored and resulted in better outcome.
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A 4-year-old female developed hypotension, tachycardia, hypoxemia, and diffuse erythema after induction of anesthesia with ketamine, fentanyl, and cisatracurium. Treatment consisted of repeated doses of epinephrine, diphenhydramine, corticosteroids, and IV fluids. ⋯ She had experienced hypotension on the ninth exposure to cisatracurium but the decrease in arterial blood pressure was attributed to propofol. On the tenth exposure to cisatracurium, the patient developed evidence of anaphylactic shock that led to the diagnosis.
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Video-assisted thoracoscopic surgery has become a common procedure in pediatric surgery. We present a case of accidental intraoperative bronchopleural fistula during a video-assisted thoracoscopic surgery procedure, which was first identified by the anesthesia team. We discuss differential diagnoses including the role of end-tidal carbon dioxide monitoring as an aid to prompt diagnosis.
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We present a patient with myasthenia gravis in whom sugammadex failed to restore the train-of-four ratio (TOFR) sufficiently. When the patient's TOFR count had recovered to 2, we administered 2 mg/kg of sugammadex. ⋯ We then administered 30 μg/kg of neostigmine which restored the TOFR to more than the preoperative value. We speculate that exacerbation of myasthenia symptoms during surgery interfered with recovery of TOFR after sugammadex administration.