Tips and Tricks in Cardiac Surgical Anesthesia

For operations including coronary artery by-pass grafting (CABG), heart valve repair or replacement, ascending aorta surgeries, heart transplantation, and surgical correction of congenital heart defects, anesthesia management shares many similar concepts

Anesthesia Management in Cesarean Section for Close Contact Parturient with COVID-19 Patient: A Case Report

During the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak, which produced a disease that had been termed COVID-19, safely treating patients that have contracted COVID-19 has become a very challenging problem for both patients and healthcare workers alike. The case we will be dealing with concerns a surgery of a full-term parturient who tested negative for COVID-19 at the time of surgery but had been living with a husband who contracted COVID-19. The parturient was taken up for an elective caesarean section under spinal anesthesia in an isolated operating room. It is necessary to consider how to manage the patient who was a close contact even if their COVID-19 test result is negative and how to set up the protocols to protect healthcare workers themselves in such situation. Keywords ---- (COVID-19, Caesarean section, Parturient, Spinal anesthesia)

Anesthesia Management in Caesarean Section with Preeclampsia and Partial HELLP Syndrome

Introduction. Pre-eclampsia is a significant cause of maternal and fetal mortality and morbidity. Pre-eclampsia is characterized by hypertension (blood pressure ≥ 140/90 mmHg), oedema and amount of protein in urine 300 mg in the 24-hour, which appears after 20 weeks of gestation. Pre-eclampsia can cause complications, one of which is HELLP syndrome. This case report discusses the use of anaesthesia in a patient who underwent a cesarean section with indications for pre-eclampsia and partial HELLP syndrome. Case Presentation. A woman, 41 years old, G4P3A0 34 weeks pregnant with pre-eclampsia + syndrome HELLP will undergo emergency cesarean section with ASA IIE physical statusLabouror pain management was carried out using regional spinal anaesthesia technique, using bupivacaine 0.5% hyperbaric agent 12.5 mg. The operation lasted for 1 hour 30 minutes, with 300 ml bleeding, hemodynamically stable. Conclusion. Difficult intubation in emergency cases can be avoided by choosing of neuraxial anaesthesia technique is recommended. It will lead to better uteroplacental perfusion, good analgesia/anaesthesia quality, reducing surgical stress, reducing drugs that enter the uteroplacental circulation, and maternal psychological to be able to see the baby at birth.

Elderly with refractory chronic severe hyponatremia and anesthesia management dilemma: a case report with literature review

Hyponatremia is a common electrolyte disorder, especially in the frail elderly population. With the increasing number of surgeries in the aging population, hyponatremia is frequently encountered by anesthesiologists and surgeons. Unfortunately, management of hyponatremia is often complex in the elderly population as it is often multifactorial, and they are physiologically susceptible. While it is well known that preoperative hyponatremia is associated with increased perioperative morbidity and mortality, a lack of recommendations or guidelines adds to the dilemma in managing such cases. The most common cause of chronic hyponatremia in the elderly is the syndrome of inappropriate antidiuretic hormone (SIADH), which can be resistant to conventional treatment. On the other hand, paraneoplastic SIADH leading to hyponatremia is rare, and surgery may be the only option available for its correction. We present a case of a 78- years-gentleman to highlight such a dilemma. He was diagnosed with renal cell carcinoma and had chronic refractory severe hyponatremia despite treatment with fluid restriction, low dose hydrocortisone, tolvaptan, and 3% sodium chloride.