A & A case reports
-
We describe a patient who presented with a bilateral pulmonary artery sarcoma, initially treated as pulmonary embolism, that necessitated concomitant pulmonary endarterectomy and pneumonectomy. We reviewed the anesthetic management used for this procedure, which bears many similarities to the management of patients undergoing pulmonary thromboendarterectomy. Right ventricular failure, pulmonary hemorrhage, and cerebral ischemia due to circulatory arrest are life-threatening perioperative complications. The anesthesiologist can play a key role in the prevention (or timely recognition and treatment) of these perioperative complications by establishing adequate hemodynamic, echocardiographic, and neurologic monitoring and by optimizing cardiopulmonary function and coagulation.
-
Postoperative blindness is an unpredictable, devastating, and yet not-uncommon complication of anesthesia. We present the case of a patient who suffered bilateral loss of eyesight after surgery. The diagnostic evidence led us to believe that it was bilateral posterior ischemic optic neuropathy; however, the true mechanisms of damage remain a matter of speculation.
-
Case Reports
Dependent Lung Tension Pneumothorax During 1-Lung Ventilation: Treatment by Transmediastinal Thoracentesis.
Contralateral tension pneumothorax during 1-lung ventilation is rare but life threatening. We report the case of a patient who developed tension pneumothorax of the dependent lung during 1-lung ventilation while the surgeon was anastomosing the bronchi after sleeve lobectomy. ⋯ As soon as the surgeons pierced the mediastinal pleura, adequate circulation was restored. Immediate diagnosis and treatment is important for this complication.
-
Epidural blood patch is a frequently successful treatment for postdural puncture headache. It is not clear whether a recent epidural blood patch affects subsequent neuraxial analgesia. ⋯ The patient successfully received analgesia from a combined spinal epidural without further complications. We discuss the anesthetic considerations for providing neuraxial analgesia after a recent epidural blood patch.
-
We present the case of an asymptomatic 82-year-old patient with no coronary artery disease and a negative cardiac workup who presented to the hospital for an elective total knee replacement. The patient had stable vital signs in the preanesthesia holding unit, yet the anesthesiologist recognized new-onset atrial fibrillation on the patient's monitor. ⋯ An echocardiogram revealed a pulmonary embolism. This case report illustrates the need for a questioning attitude and diligent monitoring in all phases of perioperative care.