Background: Oesophageal submucosal hematoma is a rare perioperative complication. When this complication develops after endovascular surgery, which requires postoperative antiplatelet therapy, whether to stop antiplatelet therapy or not is controversial. If antiplatelet therapy is discontinued, the appropriate time to resume antiplatelet therapy is unclear. Case presentation: A 75-year-old woman (height 134 cm, weight 37 kg) underwent flow diverter embolization for unruptured cerebral aneurysm under general anaesthesia. The patient received dual antiplatelet therapy before surgery and anticoagulation therapy intraoperatively. After surgery, the patient developed hematemesis and was diagnosed with oesophageal submucosal hematoma. Conservative treatment was initiated after discontinuing antiplatelet therapy, which was resumed 3 days after surgery. The patient showed good recovery even after the resumption of antiplatelet therapy. Conclusions: In our case, we successfully treated oesophageal submucosal hematoma developing after endovascular surgery with early resumption of postoperative antiplatelet therapy.
Background
Patients with renal failure are susceptible to electrolyte disturbances including life-threatening hyperkalemia, and intraoperative hepatic damage exacerbates it. We report a case on hemodialysis who developed intraoperative remarkable hyperkalemia caused by hepatic damage during laparoscopic gastrectomy.
Case presentation
A 48-year-old man underwent laparoscopic gastrectomy for gastric cancer. He had been on hemodialysis for chronic renal failure. Serum K+ continued to increase to a maximum level of 7.4 mEq/L, despite the infusion of glucose with insulin during surgery. Postoperative computed tomography revealed hepatic infarction. Combined with increased hepatic enzymes, hepatic infarction caused by intraoperative mechanical traction would have exacerbated hyperkalemia.
Conclusions
We report a case on hemodialysis who developed intraoperative hyperkalemia due to hepatic damage. Our case highlights hepatic damage during laparoscopic gastrectomy as a potential cause of hyperkalemia.
Background: The diagnostic efficacy of lung ultrasonography (LUS) has been widely investigated. However, the clinical value of LUS for perioperative monitoring has rarely been reported. The aim of this study was to evaluate the ability of LUS to assess lung aeration status after one-lung ventilation (OLV) using a validated scoring system.
Methods: In this prospective observational study, patients undergoing elective video-assisted thoracic surgery (VATS) with OLV underwent a lung ultrasound examination just after induction of anesthesia and at the end of the surgery. After each lung ultrasound examination, a semiquantitative score, the LUS score, was calculated to assess lung aeration on the ventilated dependent side and the non-dependent side separately. The relationship between the LUS scores and various patient-related factors was also investigated.
Results: Twenty-five patients were studied. All lung ultrasound examinations were successfully completed. LUS scores after OLV on the dependent side (median [IQR]: 2 [1–4]) increased significantly from baseline (1 [0–1.5], P < 0.001). Further, LUS scores on the non-dependent side (2 [1.5–3.5]) increased significantly from baseline (1 [0–1.5], P < 0.001). None of the factors analyzed was significantly correlated with LUS scores after OLV.
Conclusion: LUS examination is possible after VATS with OLV on both sides of the thorax. Ultrasonography-measured lung aeration scores increased from baseline on both sides.
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