Critically High Carboxyhemoglobin Level following Extensive Hysteroscopic Myomectomy
We present a case of a 36-year-old woman (Gravida 0, Para 0) with abnormal uterine bleeding-leiomyoma and resultant anemia, undergoing hysteroscopic resection of a large submucous myoma. During surgery, the patient was found to have a critically elevated level of carboxyhemoglobin and accompanying electrocardiogram derangements. She was managed with prolonged intubation, 100% O2, and trending of her carboxyhemoglobin levels before extubation. This demonstrates the importance of being cognizant of the potentially toxic gaseous byproducts of bipolar resection and of including intravasation of these byproducts in one's consideration of patient safety during extensive resections. Bipolar hysteroscopic resection of large leiomyomas may result in critically high carboxyhemoglobin levels, which can impair end-organ oxygen delivery with resultant ischemia; the risks of myocardial ischemia should be discussed with the anesthesia team before attempting an extensive resection. Electrocardiogram changes indicative of ischemia should prompt discontinuation of the case. Finally, carboxyhemoglobin poisoning should be included in the differential diagnosis of patients who demonstrate longer-than-expected anesthesia recovery times after bipolar resection of large submucous leiomyomas, and they should be managed with repeat evaluation of carboxyhemoglobin levels, supplemental oxygen, and cardiac monitoring.
Coronavirus outbreak has caused a 51% increase in demand for sedatives and anaesthetics in March
Publication date: Available online 30 March 2020Source: Journal of Minimally Invasive GynecologyAuthor(s): HaiLing Liu, Jialun Song, FangFang Zhang, JiaMei Li, WeiYa Kong, ShangGe Lv, LinZhang, Lei Yan
Objective: To examine the relationship between menopausal status and mental well-being, and whether this relationship varies as a function of physical activity (PA). Methods: Based on a hormonal analysis and bleeding diary, women aged 47 to 55 were categorized as pre (n = 304), early peri (n = 198), late peri (n = 209), or postmenopausal (n = 387). Mental well-being was assessed using the Centre for Epidemiologic Studies Depression Scale, the International Positive and Negative Affect Schedule Short Form, and the Satisfaction with Life Scale. PA was self-reported and categorized as low, medium, and hig...
Objective: The aim of the study was to evaluate the effect of a single-capsule 17β-estradiol/progesterone (E2/P4), TX-001HR, on endometrial safety, to report on amenorrhea and bleeding patterns of users, and to identify predictors of amenorrhea. Methods: The REPLENISH trial (NCT01942668) evaluated use of TX-001HR in menopausal women (40-65 y) with vasomotor symptoms (VMS) and a uterus. Women were randomized to daily E2/P4 (mg/mg: 1/100, 0.5/100, 0.5/50, or 0.25/50), or placebo for 12 months. Incidence rate of endometrial hyperplasia was calculated from endometrial biopsies conducted at screening and study complet...
No abstract available
Conclusions: Intrathoracic fistulas remain a source of major morbidity and mortality. Reinforcement of the fistula closure with vascularized muscle flaps is a viable option for preventing dehiscence of the repair site and can be potentially life-saving. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
European Journal of Heart Failure, EarlyView.
FDA issues Emergency Use Authorization allowing for emergency use of certain anesthesia ventilators
Condition: Fluid Overload Interventions: Other: oxytocin and spinal anesthesia; Other: General anesthsia Sponsor: University of Jordan Completed
Condition: Severe Aplastic Anemia (SAA) Interventions: Drug: eltrombopag; Drug: rabbit anti-thymocyte globulin (r-ATG); Drug: cyclosporine A (CsA) Sponsor: Novartis Pharmaceuticals Not yet recruiting