Transesophageal Echocardiography-Guided Cardiopulmonary Resuscitation After Rocuronium Anaphylaxis
This report describes a case of rocuronium anaphylaxis which progressed to circulatory arrest despite intravenous epinephrine and crystalloid resuscitation. Transesophageal echocardiography performed during cardiopulmonary resuscitation enabled rapid identification of the cause of shock and redirected management to prioritize further fluid administration, leading to return of spontaneous circulation with a good outcome. The etiology of shock in anaphylaxis can be variable, and transesophageal echocardiography can rapidly identify the likely mechanism and guide treatment without interrupting ongoing resuscitative efforts. (...
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Diagnostic Ultrasound Rounds Source Type: research

Coronavirus Disease 2019: In-Home Isolation Room Construction
Patient care duties will expose health care workers to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Many are concerned about subsequent household exposure to their families, particularly those family members with high risk of complications or mortality, potentiating additional community spread. Herein is described a temporary isolation room that can be created within a home, thereby decreasing bioburden exposure to family members. The design is simple, expedient, and can be built with locally sourced inexpensive supplies. A viewing and access window facilitates safe family interaction and decreases the emo...
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Innovation Source Type: research

Development and Implementation of a Nonclinical Professional Development Rotation
Residency programs often struggle with strategies to formally teach leadership and communications skills. To provide a catalyst for professional development, Vanderbilt University Medical Center implemented a curriculum aimed at addressing this gap. Starting in 2014, the authors implemented a 2-week professional development rotation for first-year anesthesiology residents. Experts provided a series of didactic and experiential sessions focused on various professional development topics. Outcomes were assessed using pre- and postrotation surveys. Sixty-nine residents completed the rotation over a 4-year period, and 82% (54 ...
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Educational Tool Source Type: research

The Venoarterial Extracorporeal Membrane Oxygenation Weaning Checklist
We present the different aspects of weaning and provide an evidence- and experienced-based guide for clinicians managing patients under vaECMO in the preweaning, weaning, and postweaning phases. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Educational Tool Source Type: research

Check the Blood Pressure!: An Educational Tool for Anesthesiology Trainees Converting Epidural Labor Analgesia to Cesarean Delivery Anesthesia
Recognition and treatment of maternal hypotension during epidural anesthesia administration for intrapartum cesarean delivery preserves maternal-fetal perfusion. A case that required quality assurance review uncovered lapses in maternal hemodynamic monitoring during the transition to intrapartum cesarean delivery anesthesia. To address this, a practice outline was designed for trainee’s education describing intrapartum epidural dosing for cesarean delivery and adequate blood pressure monitoring. The time-lapse between epidural dosing and subsequent blood pressure was evaluated before and after the introduction of our...
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Educational Tool Source Type: research

Thoracolumbar Interfascial Plane Block for Spinal Cord Stimulator System Implantation: A Case Series
We describe the sonoanatomic landmarks of this technique, and we report results of this retrospective case series on analgesic impact of this block in patients undergoing implantation of spinal cord stimulation systems. Clinical studies are required to investigate the analgesic role of TLIPB for spinal thoracolumbar surgery. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Series Source Type: research

Effective Use of Angiotensin II in Coronavirus Disease 19–Associated Mixed Shock State: A Case Report
We present a case of an elderly woman with multiple comorbidities who developed severe acute respiratory distress syndrome (ARDS), a cardiomyopathy, and vasodilatory shock secondary to COVID-19 and was treated with exogenous angiotensin II. She rapidly demonstrated significant hemodynamic improvement without noted adverse effects. Thus, we propose further investigation into possible benefits of angiotensin II in shock secondary to COVID-19. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Ambulatory Erector Spinae Plane Continuous Nerve Catheter for Acute Pain Management Following Rib Resection for Slipping Rib Syndrome in an Adolescent: A Case Report
We report the placement of an erector spinae plane (ESP) catheter in a pediatric patient who underwent rib resection for slipping rib syndrome and was discharged on postoperative day 1 with an elastomeric pump for continued regional analgesia in the ambulatory setting. The patient required minimal opioids while the catheter was in place and experienced a functional level that surpassed her preoperative state. Ambulatory ESP peripheral nerve catheters are a feasible and potentially effective option for the treatment of acute postsurgical pain in children. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Systemic Air Embolism in a Patient With Lung Lesion Undergoing Neurosurgery in Sitting Position: A Case Report
We report a case of a 53-year-old woman with chronic obstructive airway disease and a preexisting fibrocavitary lung lesion, who developed isolated air entrainment into the left heart during sitting position surgery. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Successful Combination of Neuraxial and Regional Anesthesia in a Child With Advanced Spinal Muscular Atrophy Type 1 Receiving Maintenance Nusinersen Therapy: A Case Report
Spinal muscular atrophy (SMA) is an autosomal recessive condition characterized by degeneration of the anterior horn cells of the spinal cord, which causes progressive muscle atrophy and weakness. SMA type 1 is the most common type and is associated with severe disability and early mortality. Concomitant restrictive respiratory physiology often manifests with significant implications for anesthetic management. Here, we describe a successful spinal anesthetic for orthopedic surgery in an SMA type 1 patient receiving intrathecal nusinersen maintenance therapy, an antisense oligonucleotide designed to increase expression of t...
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Prophylactic Physostigmine for Extreme and Refractory Adult Emergence Delirium, Aimed at Increasing Patient Safety and Reducing Health Care Workplace Violence: A Case Report
We present the case of a patient with Barrett esophagus and a history of severe and refractory emergence delirium, who was successfully treated prophylactically with physostigmine, resulting in decreased risk of harm to the patient, trauma to the perioperative staff, and a safer and more positive recovery. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Advanced Progression of Scoliosis After Intrathecal Baclofen in an Adult With Stiff Person Syndrome: A Case Report
We report a case of an adult with stiff person syndrome and underlying scoliosis who experienced accelerated progression of scoliosis after initiation of intrathecal baclofen, subsequently requiring neurosurgical intervention. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Cesarean Delivery in a Parturient With “Repaired” Congenital Mitral Dysplasia and Severe Functional Mitral Stenosis: A Case Report
We present the anesthetic management of a 23-year-old gravida 2 para 0-0-1-0 with a history of mitral valve replacement secondary to congenital mitral dysplasia. The hemodynamic changes of pregnancy had resulted in severe functional mitral stenosis of her mechanical valve, which was significantly undersized for her current body surface area. Her complex cardiac history required our multidisciplinary team to focus on peripartum anticoagulation management, extracorporeal membrane oxygenation (ECMO) preparation under a dural puncture epidural (DPE) technique, and managing the hemodynamic changes that are critical for a congen...
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Anesthetic Management for a Patient With MECP2 Duplication Syndrome: A Case Report
This article presents a case of a patient with MECP2 duplication syndrome who required general anesthesia for respiratory workup and reviews the anesthetic management for these patients, which includes induction technique, choice of drugs, and other major anesthetic concerns. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Pectoral Nerve Block Type II as the Sole Anesthetic for Removal of a Large Axillary Tumor: A Case Report
This report describes the first use of the Pecs II block as the sole anesthetic for axillary surgery. A patient needed resection of axillary masses. She was not only very reluctant to have general anesthesia but also considered high risk because of multiple comorbidities. An ultrasound-guided Pecs II block was performed. Both masses were resected without additional sedation or analgesia. This case report suggests that, in selected cases, the Pecs II block can be used as the sole anesthetic for axillary surgery. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Congenital Tracheal Aplasia Without Prenatal Diagnosis Masked by Maternal Obesity and Gestational Diabetes: A Case Report
This case report describes a neonate with tracheal aplasia first diagnosed after birth due to the presentation of respiratory distress, absence of crying, and unsuccessful tracheal intubation. The most common finding with tracheal aplasia is polyhydramnios. However, diagnosis remains challenging in the prenatal period. In this case, maternal obesity and gestational diabetes made diagnosis more difficult. The only lifesaving treatment available is ventilation through esophageal intubation or tracheostomy. However, in some cases, tracheostomy is not an option. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Placement of a Double-Lumen Endotracheal Tube Using a Combined Bronchoscopy and Fluoroscopy Technique: A Case Report
Bronchial artery embolization (BAE) is a well-established intervention for hemoptysis that requires airway management by a trained anesthesiologist. The use of fluoroscopic guidance for positioning a double-lumen endotracheal tube (DLT) has been described in previous studies. The case presented illustrates a combined fluoroscopic- and bronchoscopic-guided approach for positioning a DLT in a patient with active pulmonary hemorrhage causing obstruction of views on bronchoscopy. This combined technique proved valuable in a situation marked by high clinical urgency. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Intermediate Cervical Plexus Block: A Novel Intervention in the Management of Refractory Chronic Neck and Upper Back Pain Following Whiplash Injury: A Case Report
Chronic neck and upper back pain occurs in 40%–60% of patients that suffer whiplash injury. Increasing evidence points to a dysfunction of the cervical and thoracic muscles as the predominant cause of persistent pain in this cohort. Response to standard management including physiotherapy, psychotherapy, medications, and acupuncture are often inadequate. As a result, there is significant functional impairment leading to excessive health care costs. The authors present a novel treatment, intermediate cervical plexus block with depot steroids, in 3 patients presenting with refractory chronic neck and upper back pain fro...
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Preoperative Correction of Anemia to Allow a 3000 ml Blood Loss Without Transfusion in a Jehovah’s Witness Presenting for Explantation of an Infected Hip Joint Prosthesis: A Case Report
A 70-year-old Jehovah’s Witness was treated with iron carboxymaltose intravenously, recombinant human erythropoietin alpha subcutaneously, and vitamin B12 and folate orally for 9 weeks to raise hemoglobin (Hb) from 10.8 to 17.0 g/dL before explantation of an infected hip joint prosthesis. The target Hb was calculated from the following formula: Hbtarget = Hbfinal/(1 − ABL/EBV), where Hbtarget= Hb to achieve before surgery, Hbfinal = lowest Hb patient could tolerate taking into consideration his comorbidities (7 g/dL), ABL = volume of blood the surgeon estimated the patient would lose intra- and po...
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

A Case Report of Slowly Evolving Epidural Hematoma After Lumbar Drain Removal Following Initiation of Clopidogrel Therapy
We report a case of slowly evolving epidural hematoma following the initiation of clopidogrel therapy in a patient with an indwelling lumbar drain. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Spinal Cord Stimulation for Neurogenic Thoracic Outlet Syndrome: A Case Report
Despite conservative and surgical treatments, patients with neurogenic thoracic outlet syndrome can develop debilitating chronic pain of the shoulder and arm. Here we report a case of a patient who failed medical treatment, surgical resection of the first rib, and subsequent resection of rib regrowth with partial excision of a hypertrophied middle scalene muscle. Ultimately, this patient was successfully treated with spinal cord stimulation with dramatic pain relief and remarkable functional improvement for more than 3 years. This first report provides hope for those who suffer from this debilitating syndrome. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Role of Multimodal Cerebral Oximetry Monitoring in the Anesthetic Management of a Patient With High-Grade Intracranial Arteriovenous Malformation: A Case Report
We report the role of intraoperative multimodal monitoring of cerebral oxygenation in the anesthetic management of a patient with grade III intracranial arteriovenous malformation (AVM) presenting for surgical excision. Real-time monitoring of cerebral oxygenation is of much relevance in high-grade AVMs where anesthetic management is focused on neuroprotection and prevention of cerebral hypoxia. Besides, it also helps in prediction, early detection, and judicious management of perioperative complications, which are commonly encountered in high-grade AVMs. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Iatrogenic Aortic Intramural Hematoma: Guidance to Intraoperative Decision Making: A Case Report
We report a unique case of iatrogenic IMH complicating a routine coronary artery bypass graft surgery (CABG) and how imaging guided intraoperative decision making toward conservative management. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Postpartum Headache due to Cerebellar Infarct Initially Misdiagnosed as Postdural Puncture Headache: A Case Report
We present the case of a 39-year-old woman with postpartum cerebellar infarction (CI) following spinal anesthesia for cesarean delivery. The patient experienced mild headache after postoperative day 1 and returned on postoperative day 6 with a severe headache. For the subsequent 3 days, she underwent conservative treatment for presumed postdural puncture headache (PDPH) before neurologic decline and diagnosis of CI on postoperative day 9. She subsequently underwent craniotomy and debridement of necrotic tissues. Prolonged or position-independent postpartum headache should prompt broadening of the differential diagnosis bey...
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Münchhausen Syndrome: A Case Report of an Unusual Cause of Vitamin K Antagonist Intoxication
Psychiatric disorders must be considered in the differential diagnosis of patients presenting to the emergency department with unexplainable somatic symptoms. Physicians should be aware of Münchhausen syndrome as a possible diagnosis. A 46-year-old female patient presented at the emergency department with signs of coagulopathy. She denied taking any anticoagulant drugs as well as rat poison. Urine toxicology revealed the presence of vitamin K antagonists (VKAs). After an extensive workup, she was diagnosed with Münchhausen syndrome. Intentional intoxication with VKA is rare. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Fatal Clostridium perfringens Meningitis Following Caudal Anesthesia in an Infant: A Case Report
Caudal anesthesia is referred to as a simple and safe method to obtain analgesia in infants during various surgical procedures. Here, we present a fatal course of a premature infant that received caudal anesthesia for inguinal hernia repair. While anesthesia and surgery were uneventful, the child developed an acute bacterial meningoencephalitis within a few hours. Microbiology revealed the presence of Clostridium perfringens in the cerebrospinal fluid (CSF). The infant died 17 days after surgery. Preoperative screening for C. perfringens and particular caution in infants with intracerebral hemorrhages are discussed as pote...
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Management of Quebec Platelet Disorder for Cervical Facet Injections in the Outpatient Setting: A Case Report
We report a patient with QPD and extensive history of postprocedural bleeding complications (PPBCs) who presented with chronic cervical facet pain. After consulting a hematologist and administering antifibrinolytic agent with platelet transfusions, the patient underwent medial branch nerve blocks (MBNBs) followed by radiofrequency ablation (RFA) without experiencing PPBCs. A comprehensive team approach is critical to maximize patient safety when performing an ISP in such a population. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Videolaryngoscope-Assisted Double-Lumen Endotracheal Tube Intubation in an Awake Patient With Known Difficult Airway and Bronchopleural Fistula: A Case Report
We present a case of a patient with a known difficult airway, bronchopleural fistula (BPF), and acute respiratory distress syndrome (ARDS) who was intubated with a double-lumen endotracheal tube (DL ETT) under awake condition using a videolaryngoscope. Independent lung ventilation (ILV) was instituted because of the BPF. The patient was treated successfully for ARDS and discharged home. To our knowledge, this is the first reported case of successful videolaryngoscope-assisted DL ETT intubation in an awake patient. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

From Tracheal Stenosis to Tracheostomy Displacement: A Case Report on a Seemingly Never-Ending Difficult Airway
We report a case of undiagnosed tracheal stenosis that culminated in acute respiratory failure in an inpatient unit. After failed intubation attempts, the placement of a supraglottic airway resulted in successful ventilation and was followed by a tracheostomy in the operating room. Postoperatively, the tracheostomy tube became accidentally dislodged necessitating emergency measures with eventual reinsertion of a longer tracheostomy tube. We present this case to highlight life-saving airway strategies that may be considered in such emergency situations and propose 2 simple algorithms to guide anesthesiologists in managing s...
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Spinal Anesthetic in a Patient With a Platelet Count of 7000 × 109/L and Undiagnosed Thrombotic Thrombocytopenic Purpura: A Case Report
A parturient with unknown thrombotic thrombocytopenic purpura (TTP) received spinal anesthesia for cesarean delivery with subsequent discovery of a platelet count of 7000 × 109/L. Neurologic recovery was normal. Limited data exist to determine the risk of spinal epidural hematoma (SEH) in severely thrombocytopenic patients because they often receive alternate labor analgesia or general anesthesia during cesarean delivery. There is reporting bias in the literature toward cases in which severely thrombocytopenic patients sustain complications after regional anesthesia. It is important to report all cases of neuraxial a...
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Actimetry-Documented Persistent Periodic Limb Movements During EEG-Confirmed Deep General Anesthesia: A Case Report
Motor activity during general anesthesia (GA) without neuromuscular blockade is often interpreted as reflecting insufficient anesthesia. Here we present the case of an octogenarian undergoing deep sclerectomy with opioid-sparing electroencephalography (EEG)-guided anesthesia. Periodic leg movements (PLM) appeared during ongoing surgery while the patient’s raw EEG displayed a pattern of deep anesthesia, evidenced by burst suppression. Recognizing PLM in the context of opioid-sparing GA is of importance for anesthesiologists, as deep anesthesia is not necessarily associated with a decrease in motor activity. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

The Application of ROTEM in a Parturient With Antiphospholipid Syndrome in the Setting of Anticoagulation for Cesarean Delivery: A Case Report
A 35-year-old parturient with antiphospholipid syndrome and a working diagnosis of hemolysis, elevated liver enzyme, and low platelets (HELLP) underwent a cesarean delivery 9 hours after receiving heparin. Her preoperative activated partial thromboplastin time and rotational thromboelastometry (ROTEM) intrinsic pathway (INTEM) clotting time were 120 and 1870 seconds, respectively. Fresh frozen plasma was administered for heparin neutralization. The ROTEM INTEM/heparinase assay (HEPTEM) ratio can help confirm heparin neutralization and guide intraoperative transfusion management. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Dual RVAD-ECMO Circuits to Treat Cardiogenic Shock and Hypoxemia Due to Necrotizing Lung Infection: A Case Report
We describe the case of combined cardiogenic and distributive shock due to necrotizing pulmonary blastomycosis. After initial central VA-ECMO cannulation, acute respiratory distress syndrome (ARDS) with increasing shunt resulted in significant central hypoxemia due to progressive ventilation-perfusion mismatch. An additional circuit provided complete oxygenation of the high circulating volume. After 4 months on support, he underwent successful heart-lung-kidney transplantation. Dual ECMO circuits are technically feasible and may be advantageous in specific circumstances of high pulmonary shunting resulting in excessive hyp...
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Hypoalbuminemia-Related Prolonged Sedation After General Anesthesia: A Case Report
A 69-year-old man underwent total laryngopharyngectomy with radial forearm free flap reconstruction. He had lost 15 kg over a period of 6 months and did not receive any preoperative nutritional workup or management. The patient had a general total intravenous anesthetic with ketamine, lidocaine, and propofol, which was uneventful for an 8-hour surgery. The patient remained deeply sedated for 4 hours after discontinuation of all sedative medications. Diagnostic workup only revealed hypoalbuminemia and hypoproteinemia. We hypothesized relative overdosage of sedative anesthetic drugs due to preoperative malnutrition accentuat...
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Unintentional Infiltration of High Dose Epinephrine in an Infant: A Case Report
This report emphasizes the need to have strategies in place to prevent medication errors. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Unexpected Shocks From a Subcutaneous Implantable Cardioverter-Defibrillator Despite Attempted Reprogramming and Magnet Use: A Case Report
We present the case of a patient with a subcutaneous implantable cardioverter-defibrillator (S-ICD) in situ. Device interrogation and reprogramming were unsuccessful due to a software mismatch between the device and programmer. The device manufacturer recommended magnet application to suspend antitachycardia therapy. Despite using this strategy, the S-ICD discharged multiple times. The S-ICD has unique perioperative considerations for the anesthesiologist. This case provides an example of the complexity of electrophysiologic devices in current use and the necessity of the anesthesia provider to stay up to date with evolvin...
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Unanticipated Myocarditis in a Surgical Patient Treated With Pembrolizumab: A Case Report
We report a case of fatal immune checkpoint inhibitor (ICI)–associated myocarditis in a 77-year-old man with metastatic non-small cell lung cancer (NSCLC) who presented for mediport placement at our outpatient surgical center. He denied any cardiac complaints and had a previously normal electrocardiogram (EKG) off treatment. Intraoperatively and postoperatively, he displayed cardiac rhythm abnormalities. The patient was then transferred to a tertiary facility, where he expired within 48 hours. As cancer immunotherapy becomes increasingly prominent, ICI-associated myocarditis should be considered a potentially critica...
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Valve Failure in the Gas Monitor: An Unusual Cause of Falsely Low Capnography Values Under General Anesthesia: A Case Report
We present a case in which the Dräger Primus (Dräger Medical AG&Co KG, Lüberck, Germany) anesthesia monitor displayed false readings of low end-tidal carbon dioxide (Etco2) immediately after intubation. The patient’s physical examination, vital signs, and arterial blood gases were normal. The ventilator, circuit, gas sample line, and water trap appeared intact and functional. A second gas analyzer revealed normal Etco2 readings, correlating with blood gas values. The defective monitor gas flow rates and gas calibration values were inappropriately low. Partial opening of the solenoid zero valve allo...
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Refractory Hypotension Following Elective Total Hip Replacement Surgery in a Patient Treated With Herbal Medicine: A Case Report
We describe refractory postoperative hypotension due to adrenal insufficiency in a patient treated with steroid-adulterated herbal medicine. A 62-year-old man underwent an elective total hip replacement. Surgery was uneventful, but he became profoundly hypotensive 8 hours later, requiring intensive care unit admission, intubation, vasopressor support, and renal replacement therapy. Subsequent workup revealed that he had been consuming a herbal medication adulterated with prednisolone. Adrenal insufficiency secondary to chronic exogenous steroids was diagnosed following cortisol measurements and an adrenocorticotropic hormo...
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Correlation Between Processed Electroencephalogram and Clinical Findings During Wake-Up Test in Prone Position for Scheduled Posterior Cervical Spine Surgery: A Case Report
A 65-year-old man undergoing posterior cervical decompression and fusion demonstrated absent lower extremity evoked potential (EP) after prone positioning and before incision. Localized EP change pointed to either a technical or positional culprit. After excluding technical causes, we performed a wake-up test to rule out positioning as the culprit. During the test, we observed both symmetrical and asymmetrical hemispheric changes in density spectral array β and γ bands that correlated with awakening, eye-opening, and extremity movements. By providing real-time information on brain state, processed electroencepha...
Source: A&A Case Reports - April 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Use of Common Carotid Intima-Media Thickness Measured by Ultrasound Echo-Tracking in Cardiovascular Risk Stratification Before Noncardiac Surgery in Low-Risk Category: A Research Idea
This report suggests evaluating common carotid intima-media thickness (CCIMT) as measured by ultrasound to determine whether it strengthens and optimizes perioperative Bayesian risk indices. The idea proposes to use CCIMT Z score and vascular age to quantify atherosclerotic burden. CCIMT may be useful as part of shared decision-making for perioperative care. A website (www.suhitam.com/vascularage) designed by one of the authors (S.M.) is a useful resource.) (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2020 Category: Anesthesiology Tags: Innovation Source Type: research

Longitudinal Competency-Based Point-of-Care Ultrasound Curriculum in Anesthesiology: Description and Initial Experience With PGY1 and PGY2 Trainees
Point-of-care ultrasound is becoming increasingly utilized in centers throughout the country for use in perioperative regional anesthesia procedures, vascular access, diagnosis, and resuscitation. We propose an educational approach that not only spans the 4-year duration of anesthesia residency but also regularly assesses progress throughout training. We accomplish this through a flipped classroom model, in which the 12 residents in each class participate in online modules for the baseline didactic knowledge, then come to a session where they have the opportunity to work in small groups (1:2–1:3 ratio of faculty to l...
Source: A&A Case Reports - March 1, 2020 Category: Anesthesiology Tags: EducationaL Tool Source Type: research

Anesthetic Management of Posterior Sternoclavicular Joint Dislocations: A Report of 2 Cases
We present 2 cases of posterior SCJ dislocations and discuss the anesthetic management and the potential for mediastinal injuries. (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2020 Category: Anesthesiology Tags: Case Reports Source Type: research

Spinal Cord Stimulator Placement in Patient With von Willebrand Disease: A Case Report
Complex regional pain syndrome (CRPS) is a regional neuropathic pain syndrome. Excruciating pain often interferes with patients’ ability to function normally. Spinal cord stimulators (SCS) have been effective in treating pain along with signs of sympathetic overactivity in patients with CRPS. Implantation of SCS is a high-risk interventional procedure with the potential for serious bleeding and neurological consequences in the spine. Meticulous evaluation and careful optimization are needed in patients with bleeding disorders. (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2020 Category: Anesthesiology Tags: Case Reports Source Type: research

Adding to the Denominator: A Case Report of Neuraxial Anesthesia for Cesarean Delivery in the Setting of Hemolysis, Elevated Liver Enzyme, Low Platelet, Thrombocytopenia, and Pulmonary Hypertension
The acceptable platelet count for the safe provision of neuraxial anesthesia in obstetric patients is unknown. Comorbidities may sway a provider to perform neuraxial anesthesia, despite thrombocytopenia, as the putative risk of spinal–epidural hematoma may not outweigh the risks associated with general anesthesia. The case of a 22-year-old nulliparous woman undergoing a cesarean delivery with a new diagnosis of pulmonary hypertension and right heart failure, compounded with thrombocytopenia and possible Hemolysis, Elevated Liver Enzyme, and Low Platelet (HELLP) syndrome, is presented. Risks and benefits of general ve...
Source: A&A Case Reports - March 1, 2020 Category: Anesthesiology Tags: Case Reports Source Type: research

Awake Craniotomy in a Patient With History of Post-Traumatic Stress Disorder—A Clinical Dilemma: A Case Report
A 32-year-old man undergoing awake craniotomy for tumor resection was previously diagnosed with post-traumatic stress disorder (PTSD)—typically a relative contraindication for awake craniotomy. Preoperative neurocognitive assessment and counseling by a neuroanesthesiologist and neuropsychologist were undertaken to characterize his PTSD, identify triggers, and prepare him for the intraoperative events. Dexmedetomidine and remifentanil were used as intraoperative anxiolytics and analgesics. With an emphasis on open communication, the patient tolerated the awake craniotomy without complications. This case highlights the...
Source: A&A Case Reports - March 1, 2020 Category: Anesthesiology Tags: Case Reports Source Type: research

Epidural-Like Effects With Bilateral Erector Spinae Plane Catheters After Abdominal Surgery: A Case Report
This case report highlights the potential for adverse effects with the erector spinae plane (ESP) blocks. ESP blocks are an alternative to the traditional epidural and paravertebral block for postoperative analgesia due to their relative technical ease and seemingly safer profile. To date, few complications have been reported from ESP blocks or catheters. Despite its distance from the epidural space, epidural-like effects may still occur with ESP catheters, such as hypotension and motor blockade, as observed in this patient after abdominal surgery. (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2020 Category: Anesthesiology Tags: Case Reports Source Type: research

“Choledochoscope” as an Important Addition in Difficult Airway Management: A Case Report
The choledochoscope is an additional tool to manage a difficult airway. We successfully used it for the first time for awake nasal intubation in a patient with no mouth opening resulting from bilateral temporomandibular ankylosis. The visual appearance of the airway structures was not compromised. However, the shorter length and larger diameter of the choledochoscope in comparison with the fiberoptic bronchoscope are crucial limiting factors of this method. We, therefore, suggest considering a choledochoscope for intubation in patients with difficult airway as a second-line alternative when a fiberoptic bronchoscope is not...
Source: A&A Case Reports - March 1, 2020 Category: Anesthesiology Tags: Case Reports Source Type: research

Postoperative Dexmedetomidine-Induced Polyuria in a Patient With Schizophrenia: A Case Report
We present a patient with schizophrenia who developed dexmedetomidine-induced polyuria after superficial parotidectomy. Two hours after starting the dexmedetomidine infusion, urine output increased from a baseline rate of 80 mL/h to a 7-hour average rate of 400 mL/h (range, 280–560 mL/h), the serum sodium concentration increased from 132 to 139 mEq/L, and urine-specific gravity was 1.006. Following dexmedetomidine discontinuation, the urine output decreased to an average of 66 mL/h (range, 40–100 mL/h). Close monitoring of urine output and serum sodium concentration may be indicated during dexmedetomidine infus...
Source: A&A Case Reports - March 1, 2020 Category: Anesthesiology Tags: Case Reports Source Type: research

Guest Reviewers
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2020 Category: Anesthesiology Tags: Guest Reviewers Source Type: research