A & A case reports
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Case Reports
Difficult Airway Management Caused by Local Anesthetic Allergy During Emergent Cesarean Delivery: A Case Report.
Difficult airway management in the gravid patient is a well-described phenomenon. We present a case of emergent cesarean delivery complicated by a "cannot intubate, cannot ventilate" scenario that was later determined to be secondary to an allergic, IgE-mediated reaction to epidurally administered local anesthetic.
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Case Reports
Anesthetic Challenges for Posterior Spine Surgery in a Patient With Left Ventricular Assist Device: A Case Report.
With the growing rate of left ventricular assist device (LVAD) implantation, patients with end-stage heart failure and LVAD support are presenting for a variety of noncardiac surgeries. We describe a case of urgent posterior lumbar decompression for spinal stenosis in a 73-year-old man with HeartMateII LVAD, which presented significant anesthetic challenges in terms of positioning, blood loss, and coagulopathy.
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Case Reports
Anesthetic Management of a Patient With Epidermolysis Bullosa Requiring Major Orthopedic Surgery: A Case Report.
Epidermolysis bullosa (EB) encompasses a wide spectrum of rare genetic disorders in which an abnormality in collagen leads to loss or absence of normal intracellular bridges. Friction or shear forces on the skin and mucosa result in blister, bullae, and scar formation. We present our experience in the management of a patient with EB who required multiple procedures for squamous cell carcinoma of the left arm, including forequarter amputation. We describe the anesthetic challenges in caring for a patient with EB undergoing major orthopedic surgery.
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Case Reports
Incidental Cerebral Acute Subdural Hematoma After Transforaminal Lumbar Interbody Fusion: A Case Report.
We present a 68-year-old woman who developed acute cerebral subdural hematoma (SDH) early after transforaminal lumbar interbody fusion. Four hours postoperatively, the patient complained of headache and nausea. ⋯ Despite no obvious intraoperative dural damage, we suggest that cerebrospinal fluid leakage by incidental dural tear likely caused the SDH. To our knowledge, this is the first report of detected cerebral SDH immediately after spinal surgery in spite of no neurological deficits.
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Case Reports
Hyperkalemia After Laparoscopic Nephrectomy in Patients With Renal Insufficiency: A Case Report.
Laparoscopic surgery is an evolving surgical modality in children, which has been applied to increasingly more complex surgeries and patients, including patients with renal insufficiency. These patients are particularly susceptible to the challenges that laparoscopy imposes on their altered physiology, leading to marked electrolyte disturbances, including metabolic acidosis and hyperkalemia. ⋯ We report 2 cases where significant, potentially lethal hyperkalemia developed during laparoscopic nephrectomy in adolescents with renal insufficiency. Awareness of this issue, as well as adequate preparation and intraoperative monitoring are essential to preventing this life-threatening complication.