Intraoperative Use of Desmopressin for Treatment of Profound Hyponatremia in the Setting of Emergency Surgery: A Case Report
We present a case of profound hyponatremia of 102 mmol/L in a patient who required emergent operative repair for bowel obstruction. This is the first case to our knowledge that demonstrates a perioperative fluid and desmopressin treatment strategy to prevent overly rapid changes of sodium concentration in a patient with severe hyponatremia. (Source: A&A Case Reports)
Source: A&A Case Reports - July 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Fluctuating Pulse Oximetry Readings in an Adolescent With Hemoglobin Bibba: A Case Report
We report the case of an adolescent with hemoglobin Bibba and α-thalassemia. SpO2 was unexpectedly low despite stable vital signs when his hemoglobin was closer to 10 g/dL and normal when his hemoglobin was lower, presumably when there was less unstable hemoglobin because of hemolysis. (Source: A&A Case Reports)
Source: A&A Case Reports - July 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Transfusion-Associated Circulatory Overload as a Result of Plasma Transfusion to Correct International Normalized Ratio Before an Invasive Procedure: A Case Report
Plasma transfusion is commonly used to correct elevated international normalized ratio (INR) before invasive procedures. A 54-year-old woman presented to the emergency department with abdominal pain. Workup revealed Streptococcus pneumoniae peritonitis. Her hospitalization was complicated by respiratory failure, fluid overload, atrial fibrillation, and acute kidney injury. Patient underwent 2 paracentesis (9 L removed). Four units of plasma were transfused to correct an INR of 3.0 (goal 1.5) for a transjugular intrahepatic portosystemic shunt procedure. INR remained at 1.9, and she developed acute pulmonary edema and died ...
Source: A&A Case Reports - July 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

When Guidelines Fail: Euglycemic Diabetic Ketoacidosis After Bariatric Surgery in a Patient Taking a Sodium–Glucose Cotransporter-2 Inhibitor A Case Report
A 42-year-old woman with diabetes mellitus type 2 treated with the sodium–glucose cotransporter-2 inhibitor canagliflozin underwent elective bariatric gastric bypass. The canagliflozin was held for 24 hours preoperatively. She physiologically decompensated on postoperative day 2. Ultimately, she was diagnosed with euglycemic diabetic ketoacidosis that required intensive care management. This diagnosis was challenging to make as the patient never became hyperglycemic. We use this case to discuss the pharmacology and potential risk of perioperative sodium glucose cotransporter-2 inhibitor administration and to advocate...
Source: A&A Case Reports - July 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Treatment of Refractory Intraoperative Hypoxemia After Trauma With Venovenous Extracorporeal Membrane Oxygenation: A Case Report
We report a case of acute hypoxic respiratory failure in an adolescent with blunt chest trauma that was successfully managed with the intraoperative initiation of venovenous extracorporeal membrane oxygenation during the initial damage control surgery. (Source: A&A Case Reports)
Source: A&A Case Reports - July 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Regional Anesthesia in the Setting of Arm Replantation: A Case Report
We report the successful use of a continuous interscalene catheter in a therapeutically anticoagulated patient after midshaft humerus arm replantation. The benefits of the continuous peripheral nerve block for the patient included improved pain control and potentially improved limb perfusion making it a valuable component of this patient’s treatment. (Source: A&A Case Reports)
Source: A&A Case Reports - July 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Perioperative Management of a Child With Glucose Transporter Type 1 Deficiency Syndrome: A Case Report
Glucose transporter type 1 deficiency syndrome (GLUT1DS) causes central nervous system dysfunction including intractable epilepsy caused by impaired glucose transport to the brain. To prevent convulsions and maintain an energy source for the brain in patients with GLUT1DS, the maintenance of adequate ketone body concentrations, compensation of metabolic acidosis, and reduction of surgical stress are essential. We here report the perioperative management of a child with GLUT1DS. (Source: A&A Case Reports)
Source: A&A Case Reports - July 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Sphenopalatine Ganglion Block Successfully Treats Migraines in a Type 1 Arnold Chiari Malformation Pregnant Patient: A Case Report
A 32-year-old woman at 36 weeks gestation with a medical history of corrected Type 1 Arnold Chiari malformation presented with an intractable headache. When methylprednisolone and morphine treatment provided no relief, we performed 2 topical transnasal sphenopalatine ganglion blocks by applying 4% lidocaine drops into each nostril via a cotton-tipped applicator. The patient’s symptoms significantly improved, and she was discharged home the same day. She has been without relapse of headaches during the 6 months of follow-up by our pain service. (Source: A&A Case Reports)
Source: A&A Case Reports - July 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Conservative Management of Neuropathic Pain in a Patient With Pancoast-Tobias Syndrome: A Case Report
Pancoast-Tobias syndrome characterizes the signs and symptoms of a superior pulmonary sulcus tumor, and includes arm and shoulder pain, atrophy of intrinsic hand muscles, and ipsilateral Horner syndrome. The rarity and overall poor prognosis of patients with superior pulmonary sulcus tumors associated with Pancoast-Tobias syndrome has led to few reports detailing pain management strategies with adjunctive therapies, such as continuous infusions of ketamine and lidocaine, chemotherapy, radiation, and multimodal oral medication regimens. This case highlights the diagnosis and treatment of pain in a patient with Pancoast-Tobi...
Source: A&A Case Reports - July 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Novel Treatment Using Intravenous Dantrolene Sodium for Postoperative Exacerbated Spasticity in Multiple Sclerosis: A Case Report
We describe the clinical presentation of a patient with multiple sclerosis and the successful use of intravenous dantrolene sodium postoperatively for the treatment of exacerbated spasticity refractory to traditional management. (Source: A&A Case Reports)
Source: A&A Case Reports - July 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Naloxegol to Treat Constipation in a Patient Taking Opioids for Cancer Pain: A Case Report
Opioid-induced constipation (OIC) is a common gastrointestinal adverse effect of opioids, which can severely affect compliance and adherence to pain medication regimens and quality of life. Naloxegol has demonstrated efficacy against OIC in several studies involving patients with nonmalignant chronic pain. Here we report efficacy and tolerability of naloxegol in a 68-year-old patient with metastatic lung cancer and severe pain, treated with opioids, who presented with OIC resistant to traditional measures. Addition of naloxegol produced rapid improvement in his OIC symptoms and no apparent adverse effects while taking exte...
Source: A&A Case Reports - July 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Axillary Artery Dissection After Ultrasound-Guided Infraclavicular Brachial Plexus Block: A Case Report
A 52-year-old man with end-stage renal disease underwent ultrasound-guided infraclavicular brachial plexus block for revision of an arteriovenous fistula. On postoperative day 2, the patient developed pain and loss of motor function in the surgical extremity. A computed tomography angiogram revealed complete dissection of the axillary artery. The dissection was emergently treated with a bypass graft, resulting in complete resolution of paralysis and pain. Sensory deficits resolved over the next 3 days. Smoking, hypertension, diabetes mellitus, and chronic intake of a calcineurin inhibitor might have predisposed the patient...
Source: A&A Case Reports - July 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Thromboelastography Before Epidural Placement in a Thrombocytopenic Parturient With Gaucher Disease Treated With Imiglucerase: A Case Report
Gaucher disease is a common inborn error of metabolism leading to widespread chronic inflammation and often thrombocytopenia. Here we discuss assessment of coagulation in a parturient with Gaucher disease treated with imiglucerase, who presented with thrombocytopenia and requested epidural analgesia for planned vaginal delivery. We used thromboelastography to determine the safety of placing an epidural catheter and to plan for potential peripartum bleeding. The patient had a normal coagulation profile by thromboelastography and had uncomplicated epidural analgesia for a successful spontaneous vaginal delivery. (Source: A&A Case Reports)
Source: A&A Case Reports - July 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Rigid Esophagoscopy–Induced Aortic Rupture During Oral Gastric Tube Placement in Patient With Esophageal Stricture: A Case Report
We describe the resultant hemothorax and hemodynamic collapse and the successful treatment with massive volume resuscitation, vasopressors, and timely surgical intervention including thoracic endovascular aortic repair. We discuss the importance of rapid diagnosis, relevant anatomy, treatment modalities, and communication as cornerstones for learning. (Source: A&A Case Reports)
Source: A&A Case Reports - July 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

A Subarachnoid Hemorrhage Presenting as Massive Nasopharyngeal Bleeding: A Case Report
We describe a patient who underwent successful aneurysmal clipping, but later presented urgently with large-volume epistaxis 48 hours after the procedure. After successful intubation of the patient, subsequent angiographic imaging determined that the massive intranasal/oral hemorrhage was due to bleeding through the former operative site, from rupture of a previously unrecognized aneurysm. This series of events demonstrates the importance of selecting the most at-risk aneurysm for surgical intervention. (Source: A&A Case Reports)
Source: A&A Case Reports - July 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Treatment of Postherpetic Neuralgia With Intravenous Administration of Zinc Sulfate: A Case Report
We report 2 zinc-deficient PHN patients who received zinc sulfate intravenously as an add-on therapy to pregabalin and responded well. (Source: A&A Case Reports)
Source: A&A Case Reports - July 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Transcutaneous Electrical Nerve Stimulation in Treatment of Occipital Neuralgia: A Case Report
Occipital neuralgia is the third most common headache syndrome after migraine and tension type headaches. There is no well-established treatment regimen for a reliable cure. The current case presents a 39-year-old woman, diagnosed with occipital neuralgia of idiopathic cause. The condition was difficult to control by conservative or interventional approaches. The patient was started on conventional transcutaneous electrical nerve stimulation, 3 sessions per week. After the procedure, the patient achieved significant pain relief: 1–2/10 on the numeric rating scale, pain initially being 10/10. With maintenance therapy ...
Source: A&A Case Reports - July 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

T1 Paravertebral Catheter for Postoperative Pain Management After First Rib Resection for Venous Thoracic Outlet Syndrome: A Case Report
We present the case of a 76-year-old woman with right upper extremity swelling who underwent infraclavicular first rib resection for venous thoracic outlet syndrome. Continuous infusion of ropivacaine through a T1 paravertebral catheter, which was placed before induction of general anesthesia but after T1 and T2 paravertebral blocks, provided effective postoperative pain control. Our experience suggests that paravertebral catheter infusions of local anesthetics may be effective adjuncts to general anesthesia in patients undergoing first rib resection and warrants further investigation. (Source: A&A Case Reports)
Source: A&A Case Reports - July 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Successful Management of a Patient With X-Linked Myotubular Myopathy for Scoliosis Surgery and Previous Cardiac Arrest After Prone Positioning: A Case Report
A 15-year-old boy with X-linked myotubular myopathy associated with severe hypotonia and pectus excavatum presented for posterior spinal fusion of T2-sacrum because of rest pain and severe progressive neuromuscular scoliosis. Previously, he experienced 2 separate instances of cardiac arrest after prone positioning under general anesthesia. A preoperative computed topography angiogram in the supine and prone positions revealed inferior vena cava and right ventricular outflow tract obstruction on prone positioning. Successful positioning and posterior spinal fusion occurred by staging the procedure, correction of volume stat...
Source: A&A Case Reports - June 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Paraplegia After Laparotomy for Large Bowel Obstruction: A Case Report
This report highlights the importance of maintaining intraoperative hemodynamic stability and careful handling of the abdominal aorta, especially in underweight patients with an abdominal aortic aneurysm. (Source: A&A Case Reports)
Source: A&A Case Reports - June 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Airway Management Approach in Nasocutaneous Fistula: A Case Report
We present a case of a 63-year-old man with nasocutaneous fistula located outside the area covered by a large adult facemask. The patient was uncooperative for the standard airway assessment and any attempt at awake intubation. Positive pressure ventilation was compromised by the fistula. Although the incidence of overall complications, including fistula formation, following free flap reconstruction for oropharyngeal cancer is reported as high as 20%, few case reports detailing airway management exist. We demonstrate that it is possible to use conventional techniques to induce and ventilate a patient with a large, external...
Source: A&A Case Reports - June 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Novel Association of Juvenile Polyposis Syndrome With Atrial Septal Aneurysm and Patent Foramen Ovale: A Case Report
We present the case of a young woman diagnosed with juvenile polyposis syndrome and SMAD-4 mutation, who developed embolic strokes from an atrial septal aneurysm and patent foramen ovale. This case highlights the propensity of patients with juvenile polyposis syndrome and SMAD-4 mutations to develop atrial septal aneurysm and patent foramen ovale, and warrants appropriate cardiac workup in at-risk individuals. (Source: A&A Case Reports)
Source: A&A Case Reports - June 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Percutaneous Pulmonary Vein Stent Placement Guided by 2- and 3-Dimensional Transesophageal Echocardiography: A Case Report
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - June 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Successful Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction During Resuscitation From Cardiac Arrest by Combined Mechanical Chest Compressions and Intra-aortic Balloon Pump Counterpulsation: A Case Report
We present a patient with inferior myocardial infarction and cardiogenic shock, followed by refractory CA who underwent successful pPCI with a novel approach integrating the simultaneous use of an automated chest compression system and intra-aortic balloon pump counterpulsation. (Source: A&A Case Reports)
Source: A&A Case Reports - June 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Pecto-intercostal Fascial Block for Acute Poststernotomy Pain: A Case Report
We present a 77-year-old patient with severe acute sternal pain after coronary artery bypass graft surgery who was successfully treated with a novel peripheral regional anesthetic technique, the pecto-intercostal fascial block. This interfascial plane block may represent an effective regional anesthetic component of a multimodal analgesic strategy for cardiac surgery patients who suffer from significant pain after a median sternotomy and are typically anticoagulated. (Source: A&A Case Reports)
Source: A&A Case Reports - June 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Delayed-Onset Bilateral Vocal Cord Paralysis After Abdominal Surgery: A Case Report
A 62-year-old male patient suddenly developed severe dyspnea due to bilateral vocal cord paralysis (VCP) 4 days after an abdominal surgery. Emergent tracheostomy effectively improved the patient’s respiratory status. The present case report emphasizes that bilateral VCP could occur even several days after an abdominal surgery in patients with multiple risk factors, such as hypertension, diabetes mellitus, an older age, male sex, and an upper abdominal surgery. Even if the patient does not present with hoarseness, bilateral VCP should not be ruled out, because a slight phonetic change can be the only symptom of early-...
Source: A&A Case Reports - June 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Scrambler Therapy for the Treatment of Chronic Central Pain: A Case Report
Central pain syndromes affect several million people worldwide. A 52-year-old woman had central pain manifest as burning pain from her left foot to the knee for 12 years after treatment for a medullary cavernoma diagnosed after a right-sided brainstem bleeding episode. All this time, her baseline pain was 5–6/10 with spikes to 9–10/10 during activity. She underwent 10 daily Scrambler (Calmare) Therapy treatments (GEOMC, Inc, Seoul, Korea) with reduction in her pain from 9–10/10 to 0–0.5/10, then 5 more sessions a month later. Her baseline pain stayed at 2/10 at 140 days with spikes only to 5/10, and...
Source: A&A Case Reports - June 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Atrioventricular Disruption After Aortic Valve Surgery: Early Detection by Intraoperative Echocardiography: A Case Report
We present a case occurring during aortic valve surgery that was detected by the anesthesiologist using transesophageal echocardiography (TEE). During weaning from cardiopulmonary bypass after uneventful replacement of a severely calcified aortic valve, blood flow was seen on TEE leaving the left ventricular outflow tract just below the annulus of the aortic valve. This blood flow expanded into the aorto-mitral curtain during systole, consistent with atrioventricular groove separation. We review the pathophysiology behind groove separations and discuss diagnosis of these rare conditions using TEE. (Source: A&A Case Reports)
Source: A&A Case Reports - June 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Postoperative Hearing Loss in a Patient With Crouzon Syndrome: A Case Report
Sudden postoperative hearing loss is rare, and thought to be caused by a variety of mechanisms.1 Here we report on a patient with Crouzon syndrome who experienced multiple episodes of postoperative hearing loss, with persistent hearing loss occurring after she received nitrous oxide as part of a general anesthetic. Nitrous oxide is known to cause pressure changes in closed air spaces. Patients with craniofacial syndromes may have acoustic nerve compression from skull base and cartilage anomalies that cause narrowing of the internal acoustic meatus.2 These anatomic variations may make patients more susceptible to increased ...
Source: A&A Case Reports - June 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Benefits of Ultrasound Imaging for Placement of Caudal Epidural Blockade in 3 Pediatric Patients: A Case Report
We present 3 cases where ultrasound guidance facilitated successful placement and helped prevent complications. One infant had an unanticipated S5 dural sac necessitating needle redirection to avoid subarachnoid injection. A 5-year old had proper needle position with inability to inject secondary to needle blockage confirmed with ultrasound. An expremature infant had initial needle placement anterior to the sacrum with subsequent proper placement using real-time ultrasound imaging. Ultrasound guidance for pediatric caudal placement confers advantages and increased routine use should be considered. (Source: A&A Case Reports)
Source: A&A Case Reports - June 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Atrioventricular Disruption After Aortic Valve Surgery: Early Detection by Intraoperative Echocardiography A Case Report
We present a case occurring during aortic valve surgery that was detected by the anesthesiologist using transesophageal echocardiography (TEE). During weaning from cardiopulmonary bypass after uneventful replacement of a severely calcified aortic valve, blood flow was seen on TEE leaving the left ventricular outflow tract just below the annulus of the aortic valve. This blood flow expanded into the aorto-mitral curtain during systole, consistent with atrioventricular groove separation. We review the pathophysiology behind groove separations and discuss diagnosis of these rare conditions using TEE. (Source: A&A Case Reports)
Source: A&A Case Reports - June 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Anesthetic Management During Atrial Septostomy in a Conjoined Thoraco-Omphalopagus Twin With Tricuspid Atresia and d-Transposition of the Great Arteries Before Separation: A Case Report
We report the anesthetic care of a conjoined twin set in which one of the patients presented with tricuspid atresia, d-transposition of the great arteries, and both atrial and ventricular septal defect. A balloon atrial septostomy was performed to allow survival after a separation procedure. (Source: A&A Case Reports)
Source: A&A Case Reports - June 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Use of Laryngeal Mask Airway to Preoxygenate and Ventilate Through a Laryngeal Stoma in a Patient Undergoing General Anesthesia: A Case Report
We present the unique method of using the laryngeal mask airways externally to facilitate preoxygenation and ventilation in a patient with a laryngeal stoma. (Source: A&A Case Reports)
Source: A&A Case Reports - June 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Failure of Pulse Oximetry and Cooximetry as Monitors in a Patient With Hemoglobin MIwate: A Case Report
We present the perioperative details of a 2-year-old child scheduled for cleft palate repair. Low pulse oximetry readings after induction of anesthesia and before surgery led to the diagnosis of HbMIwate, a rare congenital methemoglobinemia due to mutation in the α-globin gene. We explored the utility of noninvasive cooximetry to monitor methemoglobin and oxygenation during anesthesia and found that noninvasive cooximetry is not useful to monitor oxygenation or to detect the percentage of methemoglobin arising from congenital variants like HbMIwate. (Source: A&A Case Reports)
Source: A&A Case Reports - June 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Total Knee Arthroplasty Revision in a Patient With End-Stage Heart Failure With a Left Ventricular Assist Device Using Peripheral Nerve Blocks: A Case Report
We report the successful use of peripheral nerve blocks for provision of surgical anesthesia for knee surgery in a patient who had end-stage heart failure, who was supported by a HeartMate II left ventricular assist device, and who was anticoagulated. We discuss the anesthetic implications involved in the care of patients being anticoagulated and on left ventricular assist device. (Source: A&A Case Reports)
Source: A&A Case Reports - June 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Drainage of Cerebrospinal Fluid and Blood Pressure Augmentation as Rescue Therapies for Ischemic Myelitis After Bronchial Embolization: A Case Report
A 62-year-old man presented to the emergency department with massive hemoptysis. After bronchial artery embolization, he developed ischemic myelitis, a rare complication in this setting for which no specific therapy is currently recommended. The symptoms were managed with lumbar drainage of cerebrospinal fluid and blood pressure augmentation therapy. To our knowledge, this is the first report of using lumbar drainage of cerebrospinal fluid and blood pressure augmentation in the treatment of anterior medullary ischemia after bronchial artery embolization for massive hemoptysis. The treatment was associated with neurological...
Source: A&A Case Reports - June 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Integrating Patient-Controlled Analgesia Using Implanted Intrathecal Pumps for Postoperative Pain Management: A Case Report
We present a case of a patient with an implanted intrathecal pump for chronic nonmalignant back pain who underwent an extensive spinal fusion surgery. The IT-PCA functionality of her intrathecal pump was successfully integrated into her postoperative multimodal pain regimen. Hence, IT-PCA can be safely incorporated into acute postoperative pain management with vigilant monitoring and close multidisciplinary collaboration. (Source: A&A Case Reports)
Source: A&A Case Reports - June 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Combined Selective Nerve Blockade and Local Infiltration Analgesia in a Total Shoulder Arthroplasty Patient With Chronic Pain and Severe Restrictive Lung Disease: A Case Report Erratum
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - May 15, 2018 Category: Anesthesiology Tags: Erratum Source Type: research

Pupillary Unrest in Ambient Light and Prediction of Opioid Responsiveness: Case Report on Its Utility in the Management of 2 Patients With Challenging Acute Pain Conditions
We report 2 cases in which PUAL identified the appropriate pain management for 2 patients, each with unique, challenging acute pain conditions. In both cases, PUAL accurately predicted opioid responsiveness, suggesting an effective, individualized analgesic approach for both patients. (Source: A&A Case Reports)
Source: A&A Case Reports - May 15, 2018 Category: Anesthesiology Tags: Case Report Source Type: research

Spinal Cord Stimulation Treatment for Chronic Right Subcostal Neuralgia Secondary to Laparoscopic Cholecystectomy: A Case Report
The use of spinal cord stimulator (SCS) treatment has been particularly effective as an adjunct in treating mixed neuropathic, nociceptive, and radicular pain conditions. There are no published studies on the use of SCS for chronic pain syndrome after laparoscopic cholecystectomy. We successfully used an SCS on a 31-year-old woman with a 4-year history of intractable right-sided subcostal pain after laparoscopic cholecystectomy. This case provides strong evidence that SCS should be considered as a treatment option for chronic postsurgical pain after laparoscopic cholecystectomy not amenable to standard therapies. (Source: ...
Source: A&A Case Reports - May 15, 2018 Category: Anesthesiology Tags: Case Report Source Type: research

Successful Removal of Intracardiac Thrombus With a Poole Tip Suction Device Through the Inferior Vena Cava of a Patient With Cardiovascular Collapse During Liver Transplant: A Case Report
We present the timely and successful use of a Poole tip surgical suction device advanced into the right atrium through a cavotomy created in the inferior vena cava to remove a large right atrial thrombus during liver transplant. The thrombus was identified with transesophageal echocardiography and was causing cardiovascular collapse. (Source: A&A Case Reports)
Source: A&A Case Reports - May 15, 2018 Category: Anesthesiology Tags: Case Report Source Type: research

Not Everything That Shakes Is a Seizure: A Case Report
We present a patient who repeatedly exhibited severe shaking at emergence from general anesthesia. Her nonepileptic myoclonus was mistaken for a refractory seizure and treated with benzodiazepines and intravenous anesthetics. The resulting depressed level of consciousness rendered myoclonus clinically indistinguishable from refractory seizures. Over the course of 6 procedures, we found that levetiracetam, a first-line antiepileptic drug, effectively suppressed her myoclonus. The episodic nature of perioperative anesthesia care presents a challenge for differentiating myoclonus from seizure while balancing the concerns rais...
Source: A&A Case Reports - May 15, 2018 Category: Anesthesiology Tags: Case Report Source Type: research

Mental Nerve Blocks for Lip Brachytherapy: A Case Report
We present the use of bilateral mental nerve blocks with minimal sedation to facilitate placement of brachytherapy catheters. (Source: A&A Case Reports)
Source: A&A Case Reports - May 15, 2018 Category: Anesthesiology Tags: Case Report Source Type: research

Safe Labeling Practices to Minimize Medication Errors in Anesthesia: 5 Case Reports and Review of the Literature
We report 5 cases of medication error as a consequence of incorrect or inappropriate labeling and analyze their cause. Recommendations for safe and practical labeling practices in anesthesia based on a review of the literature are presented. Implementation of the recommended labeling practices can reduce the risk of medication error and contribute to the safe administration of drugs. (Source: A&A Case Reports)
Source: A&A Case Reports - May 15, 2018 Category: Anesthesiology Tags: Case Report Source Type: research

Delayed Post Caudal Catheter Placement Pseudomeningocele: A Case Report
We present a rare case of a 7-month-old infant who developed a pseudomeningocele 16 days after an uneventful caudal catheter placement. The patient did not exhibit neurological deficits or signs of infection, and the mass increased in size with Valsalva maneuver. Pseudomeningocele, an abnormal collection of cerebrospinal fluid around an opening in the dura mater, can be iatrogenic or traumatic. Regional anesthesia is rarely the cause. Recognizing diagnostic features such as the lack of infectious signs and mass compressibility can prevent misdiagnosis and inappropriate invasive treatment. (Source: A&A Case Reports)
Source: A&A Case Reports - May 15, 2018 Category: Anesthesiology Tags: Case Report Source Type: research

Technique Utilizing a Modified Oral Ring-Adair-Elwyn Tube to Provide Continuous Oxygen and Sevoflurane Delivery During Nasotracheal Intubation in an Infant With a Difficult Airway: A Case Report
We describe a new method to deliver continuous oxygen and volatile anesthetic during nasotracheal intubation in an infant with PRS. (Source: A&A Case Reports)
Source: A&A Case Reports - May 15, 2018 Category: Anesthesiology Tags: Case Report Source Type: research

Baclofen Pump Replacement in a Patient With End-Stage Amyotrophic Lateral Sclerosis: A Case Report Demonstrating Transversus Abdominis Plane Block as the Sole Anesthetic
A patient with end-stage amyotrophic lateral sclerosis (ALS) presented for Baclofen pump replacement. She underwent a left transversus abdominis plane block to anesthetize the left lower quadrant of the abdomen. No sedatives or analgesics were administered, and the procedure was successfully completed without complication. It is prudent to consider anesthetic plans that avoid complications associated with general or neuraxial anesthesia in patients with ALS. This case report demonstrates successful placement of a transversus abdominis plane block in a patient with ALS and offers a safe anesthetic technique that can be perf...
Source: A&A Case Reports - May 15, 2018 Category: Anesthesiology Tags: Case Report Source Type: research

Point-of-Care Ultrasound in the Periarrest Setting—Lessons Learned: A Case Report
We present a case in which the treatment of cardiac arrest caused tension pneumothoraces and cardiac tamponade by pneumopericardium. Both pneumothorax and tamponade were expected to be identified with ultrasound, but were not. Subcutaneous emphysema precluded the diagnosis of pneumothorax. Cardiac imaging was false negative for tamponade, because the latter was caused by air and not fluid. Diagnoses are not to be excluded with inconclusive point-of-care ultrasound examinations, which should prompt further clinical evaluation and imaging. (Source: A&A Case Reports)
Source: A&A Case Reports - May 1, 2018 Category: Anesthesiology Tags: Case Report Source Type: research

Airway Management in a Patient With Tracheal Disruption due to Penetrating Neck Trauma With Hollow Point Ammunition: A Case Report
Rapid sequence induction and intubation was performed for a patient in respiratory distress after a gunshot wound to the neck. Resistance was noted distal to vocal cords. With a bronchoscope unavailable, the endotracheal tube was advanced with a corkscrew maneuver. Subcutaneous emphysema had developed. The endotracheal tube was advanced into the right mainstem with adequate ventilation. Imaging illustrated tracheoesophageal injury. The patient was emergently explored. An intraluminal bullet was removed, lateral wall tracheal defect was repaired, and a tracheostomy was placed. The intubating provider should secure the airwa...
Source: A&A Case Reports - May 1, 2018 Category: Anesthesiology Tags: Case Report Source Type: research

The Use of Liposomal Bupivacaine in Erector Spinae Plane Block to Minimize Opioid Consumption for Breast Surgery: A Case Report
We describe a patient with opioid intolerance scheduled for breast surgery who received an erector spinae plane block with liposomal bupivacaine as well as a supplemental T1 paravertebral block resulting in profound analgesia throughout her postoperative course. This case report demonstrates that use of liposomal bupivacaine in the erector spinae plane block can be successful in providing extended duration postoperative analgesia and minimizing systemic opioid requirements. (Source: A&A Case Reports)
Source: A&A Case Reports - May 1, 2018 Category: Anesthesiology Tags: Case Report Source Type: research