A & A case reports
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Case Reports
Neuraxial anesthesia for labor and delivery in a parturient with unstable cervical spine fracture.
We report the successful anesthetic management of labor and passive second-stage delivery in a parturient requiring cervical spine stabilization with a halo. A 25-year-old, Gravida 1, Para 0 at 37 weeks of gestation, admitted for observation after a recent motor vehicle collision, required induction of labor for preeclampsia. ⋯ The injury and halo presented concerns for access to her airway and preservation of neurologic status. An epidural placed early in labor allowed for adequate analgesia, as well as sacral extension for a forceps-assisted delivery.
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Acute bilateral recurrent laryngeal nerve injury leading to acute vocal cord paralysis (VCP) is a serious complication of head and neck surgery, often requiring emergent surgical intervention. Although well documented, its presentation may be sudden and unexpected, occurring despite lack of obvious intraoperative nerve injury. ⋯ We report a case of acute VCP that was successfully treated with continuous positive airway pressure via facemask ventilation. This effective temporizing strategy allowed clinicians to plan and prepare for tracheostomy, minimizing potential complications.
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The management of life-threatening bleeding associated with rivaroxaban remains a challenge for physicians due to the lack of evidence about clinically effective options for anticoagulation reversal. We report a favorable outcome in a patient receiving rivaroxaban prophylaxis, who developed a spontaneous subdural hematoma treated by a surgical evacuation and administration of 4-factor prothrombin complex concentrate. ⋯ Reversal with prothrombin complex concentrates improved all thrombin generation measures. Thrombin generation tests may be suitable for assessing the clinical utility of reversal drugs on rivaroxaban-induced coagulopathy.