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1.
Cureus ; 15(3): e36045, 2023 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-37056550

RESUMO

We report the first case of liver transplantation for fulminant hepatic failure precipitated by hepatocellular injury due to the synergistic effect of pheochromocytoma crisis and simultaneous use of Garcinia cambogia. Complex diagnosis and treatment decisions are discussed, as well as possible pathophysiology that led to liver failure.

2.
Urology ; 172: 126-130, 2023 02.
Artigo em Inglês | MEDLINE | ID: mdl-36481203

RESUMO

OBJECTIVE: To evaluate the efficacy of peri-operative acetazolamide for pain control in robotic assisted laparoscopic prostatectomy (RALP). Prior studies have demonstrated that preoperative acetazolamide decreased postoperative referred pain in the postsurgical period for laparoscopic procedures. The proposed mechanism is acetazolamide mediated inhibition of carbonic anhydrase, thereby preventing formation of carbonic acid and subsequent peritoneal acidosis with referred pain. This has yet to be demonstrated in the setting of RALP. METHODS AND MATERIALS: Patients undergoing RALP were randomized to receive either preoperative saline or acetazolamide prior to the procedure. Overall pain scores were recorded at multiple time points post operatively, as well as total morphine equivalents administered for adjunctive pain control. RESULTS: Thirty-one patients were included in the study: 16 patients (51.6%) received perioperative acetazolamide, and 15 patients (48.4%) received perioperative saline as placebo. Overall pain scores were similar for patients receiving acetazolamide compared to placebo at various time points: first responsive (3.5 ± 3.1 vs 4.1 ± 1.7, P = .28), immediately prior to leaving PACU (2.8 ± 2.9 vs 2.9 ± 2.9, P = .48), at 4 hours post-procedure (3.1 ± 3.0 vs 2.9 ± 1.8, P = .362), or at 24 hours post-procedure (2.3 ± 1.7 vs 2.2 ± 1.6, P = .5). Shoulder tip pain was not present in either cohort. No statistically significant difference was observed for total morphine equivalents delivered between acetazolamide and placebo (17.3 vs 20.5, P= .2, respectively). CONCLUSION: Acetazolamide does not appear to impact overall pain or shoulder tip pain in the observed cohort of patients undergoing RALP.


Assuntos
Laparoscopia , Procedimentos Cirúrgicos Robóticos , Masculino , Humanos , Acetazolamida/uso terapêutico , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Procedimentos Cirúrgicos Robóticos/métodos , Dor Referida , Laparoscopia/efeitos adversos , Laparoscopia/métodos , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/etiologia , Dor Pós-Operatória/prevenção & controle , Prostatectomia/efeitos adversos , Prostatectomia/métodos , Derivados da Morfina/uso terapêutico , Resultado do Tratamento
3.
A A Case Rep ; 7(7): 146-9, 2016 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-27513968

RESUMO

The maternal mortality rate for parturients with severe pulmonary hypertension is 30% to 50%. General, epidural, and combined low-dose spinal-epidural anesthesia have been used successfully for cesarean deliveries in patients with pulmonary hypertension. We describe a cesarean delivery performed using an intrathecal catheter in a 25-year-old morbidly obese (body mass index, 82 kg/m) woman (gravida 3, para 2 at 32 weeks of gestation) who had severe pulmonary hypertension, right ventricular failure, pulmonary emboli, and obstructive sleep apnea. We discuss the anesthetic considerations for parturients with severe pulmonary hypertension undergoing cesarean delivery including the selection of anesthetic technique, vasopressors, and uterotonic agents.


Assuntos
Raquianestesia/métodos , Cesárea/métodos , Insuficiência Cardíaca/cirurgia , Hipertensão Pulmonar/cirurgia , Complicações Cardiovasculares na Gravidez/cirurgia , Embolia Pulmonar/cirurgia , Disfunção Ventricular Direita/cirurgia , Adulto , Anestesia Obstétrica/métodos , Feminino , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/diagnóstico , Obesidade Mórbida/complicações , Obesidade Mórbida/cirurgia , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico , Embolia Pulmonar/complicações , Embolia Pulmonar/diagnóstico , Disfunção Ventricular Direita/complicações , Disfunção Ventricular Direita/diagnóstico
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