A & A case reports
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Perioperative hypoglycemia has been associated with adverse outcomes. Consequently, perioperative monitoring of blood glucose using convenient point-of-care (POC) monitors is frequently used. ⋯ We describe a case of pseudohypoglycemia using such testing. This case highlights the importance of individualizing perioperative glucose management to venous or arterial rather than capillary sampling in certain clinical situations.
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Case Reports
Intact Survival After Obstetric Hemorrhage and 55 Minutes of Cardiopulmonary Resuscitation.
Cardiac arrest occurs in approximately 1:12,000 parturients. Among nonpregnant patients who have in-hospital cardiac arrest, those whose spontaneous circulation does not return within 15 to 20 minutes have a high risk of death and disability, so life support efforts are generally stopped after this period. ⋯ We describe a successful clinical outcome after maternal cardiac arrest and 55 minutes of advanced cardiac life support. This case underscores the importance of high-quality cardiopulmonary resuscitation and raises questions about the appropriate duration of resuscitation efforts in otherwise healthy young mothers with a potentially reversible cause of arrest.
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A 27-year-old primigravida patient with diastrophic dysplasia (DTD) presented to our obstetrics clinic at 8 weeks' gestational age. Diastrophic dysplasia is a rare, autosomal-recessive abnormality that presents multiple challenges to perinatal anesthetic management, including difficult airway management and relative contraindications to neuraxial anesthesia. The patient underwent elective cesarean delivery at 35 weeks' gestational age under general anesthesia. In this report, we describe our preoperative evaluation and management strategy that involved a multidisciplinary care team.
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Case Reports
Hemostatic Management of Severe Thrombocytopenia in a Patient Undergoing Pulmonic Valve Replacement.
Perioperative management of thrombocytopenia is often focused on platelet transfusion. However, there are thrombocytopenic cases that are refractory to platelet transfusion as a result of immune response or consumptive coagulopathy. Acuity of the disease may necessitate an invasive procedure despite a grossly abnormal platelet count. We describe a case of severe thrombocytopenia refractory to platelet transfusion and hemostatic management after an urgent pulmonary valve replacement and pulmonary embolectomy.