A & A case reports
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Patients with primary open angle glaucoma have decreased outflow through the trabecular meshwork of the eye, resulting in increased intraocular pressure (IOP). It is known that the Trendelenburg position causes increased IOP, but there are no current guidelines for monitoring and treating patients with glaucoma undergoing surgical procedures while in the Trendelenburg position. We describe a case of successful intraoperative management of increased IOP in a patient with glaucoma undergoing robotic radical prostatectomy while in steep Trendelenburg position.
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Safe anesthesia in premature and ex-premature infants remains a challenge for the anesthesiologist. These infants are at risk of postoperative apnea, desaturation, and bradycardia after general anesthesia. ⋯ None of our patients had postoperative apnea or required neonatal intensive care admission. A possible opioid and muscle relaxant-sparing effect of peribulbar block might have reduced the incidence of postoperative complications.
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We surveyed anesthesiology residents to evaluate the predictive effect of prior residence on desired location for future practice opportunities. One thousand five hundred United States anesthesiology residents were invited to participate. One question asked whether they intend to enter academic practice when they graduate from their residency/fellowship training. ⋯ Fewer than half of those (P < 0.0001) would "very probably" consider a distant location (31.6%, 99% CI 24.4%-39.6%). Respondents with prior formal research training (e.g., PhD or Master's) had greater interest in academic practice at a distant location (AUC 0.63 ± 0.03, P = 0.0002). Except among respondents with formal research training, a good question to ask a job applicant is whether the applicant or the applicant's family has previously lived in the area.
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Retroperitoneal hematoma is a rare complication of psoas catheter placement, typically occurring several days after placement and in the setting of anticoagulation. We present the case of a patient with a history of myeloproliferative thrombocytosis receiving aspirin therapy who underwent total hip arthroplasty with preoperative psoas catheter placement complicated by immediate development of a large retroperitoneal hematoma. It is likely that the combination of aspirin therapy and thrombocytosis paradoxically placed the patient at increased risk for hemorrhagic complications. Regional techniques should be used cautiously in patients with myeloproliferative disorders, even in the presence of supraphysiologic platelet counts.