A & A case reports
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Failure of a double-lumen endotracheal tube (DLT) to isolate the lung during thoracic surgery can have significant consequences. In this report, we examine an approach for rescuing a malpositioned DLT. ⋯ A 7-Fr Arndt bronchial blocker was positioned through the tracheal lumen of the DLT to obtain 1-lung ventilation. This technique can be used to rescue a malfunctioning DLT without the need for extubating and reintubating the trachea.
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A 61-year-old female ex-smoker presented with a suspicious right lower lobe mass after previously undergoing a left pneumonectomy. Due to the peripheral nature of the lung lesion, a right thoracoscopic wedge resection was proposed by the surgical team. ⋯ The trachea was extubated in the operating room, and the patient recovered uneventfully from the procedure. This case demonstrates the feasibility of limited thoracoscopic lung resections postpneumonectomy with the use of high-frequency jet ventilation.
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I report the occurrence of left arytenoid dislocation in 2 patients undergoing laparoscopic surgical procedures formerly used only for weight loss and that are now being used for treatment of diabetes. After uncomplicated tracheal intubation, a calibrating orogastric tube was inserted into the esophagus blindly and without difficulty. ⋯ I suspect that the insertion of the calibrating orogastric tube in these nonobese patients may have led to the development of this rare complication. Recognition of its occurrence and subsequent treatment are important to preventing long-term consequences of arytenoid dislocation.
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We report the case of a man with a massive pulmonary embolism, which lead to cardiac arrest. After ruptured aneurysm clipping, he was successfully treated by rescue thrombolysis administered as compassionate treatment despite the risk of cerebral bleeding. The patient was discharged from the intensive care unit; his initial neurological, cardiac, and pulmonary conditions restored. In case of life-threatening pulmonary embolism, the risk-benefit ratio of thrombolysis therapy should be systematically evaluated and the decision adapted to each patient.
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Impetigo herpetiformis (IH), or generalized pustular psoriasis of pregnancy, is an exceedingly rare, generalized pustular skin eruption occurring during pregnancy associated with hypovolemia, sepsis, hypocalcemia, and airway edema. Fetal outcomes are generally poor, and parturients with IH may present with emergent indications for cesarean delivery due to placental insufficiency. We present a case of IH in a 19-year-old G1P0 who underwent successful general anesthesia for cesarean delivery. Her case highlights the anesthetic implications for patients afflicted with this rare disease, including perioperative pain management, airway concerns, considerations for neuraxial anesthesia, and monitoring challenges.