The Use of Transesophageal Echocardiography in the Diagnosis and Management of an Intracardiac Missile Embolism
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2020 Category: Anesthesiology Tags: Echo Rounds Source Type: research

Intraoperative Transesophageal Echocardiography Examination for Percutaneous Left Ventricular Assist Device Deactivation
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2020 Category: Anesthesiology Tags: Echo Rounds Source Type: research

Formation of an Intraoperative Educational Curriculum for Anesthesiology Residents Using a Systematic Approach
Anesthesiology residents spend most of their training in operating rooms, but intraoperative teaching is often unstructured. Needs assessment indicated a need to incorporate a more evidence-based approach to education and improvement of our methods of introducing residents to primary anesthesiology literature. Kern’s 6-step approach to curriculum development was used to create a robust and innovative curriculum to increase both the evidence-based component of our curriculum and the amount of educational intraoperative discussion among trainees and faculty. Our curriculum uses a structured topic outline, an e-journal ...
Source: A&A Case Reports - October 1, 2020 Category: Anesthesiology Tags: Educational Tool Source Type: research

Low-Volume Local Anesthetics for C5 and Supraclavicular Nerve Blocks for Mid and Lateral Clavicle Surgery: A Case Series
After institutional ethics committee approval and informed consent, 20 patients with clavicle fractures were recruited. An ultrasound-guided C5 root block was performed by injecting 3 mL of 0.5% bupivacaine with a subsequent ultrasound-guided supraclavicular nerve (SCN) block with 3 mL of 0.5% bupivacaine. A combination of low-volume C5 root block and SCN block provided reliable awake anesthesia and postoperative analgesia in patients with fractured clavicles. This technique can avoid a general anesthesia for fractures of the mid and lateral clavicle. Further studies should focus on the optimal volume of local anesthetics ...
Source: A&A Case Reports - October 1, 2020 Category: Anesthesiology Tags: Case Series Source Type: research

Bronchovenous Fistula During Adult Cardiac Surgery: A Case Report
We present a 75-year-old woman who developed a BVF during cardiac surgery. Dense adhesion in the pleural and pericardial cavities was noted. Restrictive pulmonary pathology required high airway pressure. Transesophageal echocardiography and hemoglobin measurement were helpful for the timely diagnosis of BVF, which was controlled by transection of the right upper pulmonary vein where a vent catheter had been inserted. Injuries around the cannulated site presumably initiated the BVF, which was worsened by high-pressure ventilation. Therefore, cannulation site might be a risk factor for BVF. (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Ipsilateral Vocal Cord Monitoring for Carotid Endarterectomy and Concurrent Contralateral Vocal Cord Paralysis: A Case Report
Vagus nerve injury may complicate carotid endarterectomy (CEA). The recurrent laryngeal nerve (RLN) branches from the vagus nerve, innervating the ipsilateral vocal cord. Vagus nerve injury can cause vocal cord dysfunction. Intraoperative vocal cord monitoring can detect vagus nerve injury during CEA. A patient with distorted neck anatomy from radiotherapy to treat oropharyngeal cancer and resultant right vocal cord paralysis required left CEA. Anticipating difficult neck dissection risking vagus nerve damage with associate RLN malfunction, we added vocal cord electromyography (EMG) to routine CEA electroencephalography (E...
Source: A&A Case Reports - October 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Surprisingly Successful Subdural Spinal Cord Stimulation: A Case Report
We report a case of a 59-year-old man with failed back surgery syndrome previously controlled with a spinal cord stimulator, who underwent spinal cord stimulator revision during which 1 lead was inadvertently advanced into the subdural space. Modified stimulation parameters achieved excellent, persistent pain relief, representing the first case of successful long-term subdural spinal cord stimulation. (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Emergency Control of Large Aneurysmal Bleed During Endoscopic Sinus Surgery: A Case Report
We report a case of intraoperative bleed of an internal carotid artery aneurysm during endoscopic sinus surgery. This case demonstrates that multidisciplinary coordination and prompt management can lead to a favorable outcome. (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Extensive Lumbar Sympathetic Ganglion Block Combined With Epidural Block for Primary Erythromelalgia: A Case Report
A 19-year-old-woman experienced severe burning pain in the lower extremities with erythema and swelling. She was diagnosed with primary erythromelalgia (PE). The pain was unresponsive to medications but relieved by immersing her feet in cold water. We performed a multilevel lumbar sympathetic ganglion block (LSGB) with 5% phenol at second lumbar vertebra (L2) and third lumbar vertebra (L3), and additional fourth lumbar vertebra (L4) levels. An epidural block was intermittently combined. The pain and skin lesions dramatically improved after the procedures, and she no longer needed medications or to soak her feet in cold wat...
Source: A&A Case Reports - October 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Utility of Motor Evoked Potential in Identification and Treatment of Suboptimal Positioning in Pediatric Craniovertebral Junction Abnormalities: A Case Report
Atlantoaxial dislocation (AAD) poses a significant challenge in terms of positioning and surgical fixation as there is increased risk of cord compression and ischemia. Intraoperative neuromonitoring (IONM) provides a useful tool to identify impending position-related dysfunction. Here we demonstrate the utility of using transcranial motor evoked potential (Tc-MEP) to identify and treat suboptimal positioning in a 13-year-old patient with AAD and Arnold-Chiari malformation. (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Transforaminal Sacral Nerve Neurostimulation for the Treatment of Intractable Chronic Pelvic Pain: Case Report: Erratum
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - September 1, 2020 Category: Anesthesiology Tags: Erratum Source Type: research

Intraoperative Assessment and Significance of Diastolic Mitral Regurgitation by Transesophageal Echocardiography
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - September 1, 2020 Category: Anesthesiology Tags: Echo Didactics Source Type: research

Transesophageal Echocardiographic Guidance in the Implantation of a Watchman Left Atrial Appendage Closure Device
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - September 1, 2020 Category: Anesthesiology Tags: Echo Rounds Source Type: research

User Perceptions of an Electronic Maternal Alerting System
This survey study evaluates the user experience of an electronic maternal early warning system that generates automated pages. Survey domains included the system’s effect on patient care, alarm fatigue, and continued use of the system. The response rate was 47.7% (273 of 572). A majority, 83%, felt that the system should remain in use, and 64.5% felt it improved patient safety. Of those who believed that they had received a page, 51.4% felt that they received pages “too frequently.” Although alarm fatigue was not fully evaluated, providers on our unit support the continued use of this automated maternal e...
Source: A&A Case Reports - September 1, 2020 Category: Anesthesiology Tags: Innovation Source Type: research

Dorsal Root Ganglion Stimulation Lead Fracture Within the Superficial Fascial Layers in 4 Cases
We present 4 cases of dorsal root ganglion stimulation lead fracture. In these cases, the surgical technique involved (1) traversing fascial layers for placement of leads via a Tuohy needle in the upper low back, (2) subcutaneous tunneling from the implantable pulse generator site to the lead puncture site without dissecting below the superficial fascial plane at the puncture site, and (3) connection of the lead/extension with the generator. All fractures occurred adjacent to the original lead puncture site. These cases suggest lead entrapment within the membranous fascial plane, with tension on a thin lead, is a mechanism...
Source: A&A Case Reports - September 1, 2020 Category: Anesthesiology Tags: Case Series Source Type: research

Continuous Pericapsular Nerve Group Block for Hip Surgery: A Case Series
We describe the use of this block for successful pain relief of 10 patients with hip fracture (intertrochanteric, subtrochanteric, neck of femur) scheduled for surgery and continuing analgesia in the postoperative period with a catheter inserted in the musculofascial plane as described above. (Source: A&A Case Reports)
Source: A&A Case Reports - September 1, 2020 Category: Anesthesiology Tags: Case Series Source Type: research

Placement of a Supraglottic Airway to Overcome Airway Obstruction When Performing Nasal Fiberoptic Intubation in Infants With Pierre Robin Sequence: A Case Series
Patients with Pierre Robin sequence present with numerous anatomical abnormalities that make mask ventilation and tracheal intubation challenging. In this case series, we describe a unique way to overcome upper airway obstruction with the placement of a supraglottic airway in 4 children with Pierre Robin sequence followed by flexible bronchoscopic nasotracheal intubation. This new approach is proven to be a successful method to overcome severe upper airway obstruction, provide continuous oxygenation, and allows nasotracheal intubation for intraoral procedures. (Source: A&A Case Reports)
Source: A&A Case Reports - September 1, 2020 Category: Anesthesiology Tags: Case Series Source Type: research

Continuous Intravenous Lidocaine Provides Effective Pain Control in a Palliative Child: A Case Report
We present its use to treat an 8-year-old child with devastating headaches. His symptoms stemmed from an inoperable supratentorial ependymoma that was causing thalamic bleeding and increased intracranial pressure. Many commonly used pain medications are associated with deleterious side effects such as bleeding and excessive sedation. These effects prevent lucidity for interactions, confound neurologic examination. A lidocaine infusion resulted in significant pain relief without these negative side effects. We discuss lidocaine infusion use and considerations for children suffering from intractable headaches. (Source: A&A Case Reports)
Source: A&A Case Reports - September 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Takotsubo Cardiomyopathy in a Coronavirus Disease-2019–Positive Patient: A Case Report
In this report, we describe a patient with a new manifestation of cardiac involvement in the setting of a COVID-19 diagnosis: that of takotsubo cardiomyopathy. (Source: A&A Case Reports)
Source: A&A Case Reports - September 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Pecs Blocks for Chronic Pain: A Case Report of Successful Postmastectomy Pain Syndrome Management
We present a case of PMPS and AWS successfully treated with Pecs I and II blocks and trigger point injections. At follow-up after 4 months, our patient reported 70% improvement in pain, movement, function, and discontinuation of opioids. This case presents the utility of a multimodal approach for a patient with pain after mastectomy. This case report is the first-time demonstration of Pecs blocks to treat chronic PMPS. (Source: A&A Case Reports)
Source: A&A Case Reports - September 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Anesthetic Management of Reversible Cerebral Vasoconstriction Syndrome During Vaginal Delivery: A Case Report
We report our experience with a patient with RCVS admitted for external cephalic version and subsequent vaginal delivery. (Source: A&A Case Reports)
Source: A&A Case Reports - September 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Airway Management Through a Facial Defect Resulting From Noma (Orofacial Gangrene): A Case Report
At a rural district hospital in Burundi, a 3-year-old severely malnourished girl with Noma presented to the operating room for placement of a gastrostomy tube. The child had a large left-sided facial defect as well as trismus. After induction of general anesthesia, the anesthesia provider was unable to open her mouth. Given that the hospital has no fiberoptic bronchoscope, direct laryngoscopy and intubation were performed directly through her facial defect. After securing the airway, the surgery proceeded without difficulty. (Source: A&A Case Reports)
Source: A&A Case Reports - September 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Neuroleptic Malignant Syndrome Secondary to Quetiapine in Critical Care: A Case Report
We report a case of an elderly patient who developed clinical and biochemical evidence of neuroleptic malignant syndrome (NMS) 5 days after quetiapine was commenced. Signs of NMS resolved after discontinuation of quetiapine and administration of dantrolene. Quetiapine-induced NMS has occurred with long-term use in the elderly in the outpatient setting. However, NMS has not previously been reported after treatment of ICU delirium. NMS is an important complication to consider before prescribing quetiapine in the ICU. (Source: A&A Case Reports)
Source: A&A Case Reports - September 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

First Case Report of Intubation With a Total Control Introducer and a Hyperangulated Video Laryngoscope
We describe the first use of an articulating Total Control Introducer (TCI) and video laryngoscope (VL) to guide intubation of a patient with known difficult airway. The patient was an 84-year-old woman with a Mallampati IV airway assessment, small mouth opening, limited neck extension, and micrognathia. We utilized a VL to visualize the glottis and an articulating TCI for endotracheal tube placement. Anteflexion and retroflexion of the introducer tip allowed dynamic navigation through the upper airway and into the trachea. Intubation was performed on first attempt without complications. (Source: A&A Case Reports)
Source: A&A Case Reports - September 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Methemoglobinemia Unmasked by Use of Sodium Nitroprusside and Hypothermia in a Case of Chronic Thromboembolic Pulmonary Hypertension During Pulmonary Endarterectomy: A Case Report
In performing pulmonary endarterectomy (PEA) for a patient with chronic thromboembolic pulmonary hypertension (CTEPH), we encountered methemoglobinemia that was unmasked by hypothermia while on cardiopulmonary bypass (CPB). The patient on dapsone therapy for antiphospholipid antibody syndrome had developed acquired methemoglobinemia that went undiagnosed because her cyanosis was believed to be due to CTEPH and the resulting ventilation-perfusion (V/Q) mismatch. Although pharmacological triggers for methemoglobin are well known, causation by hypothermia is not described. Monitoring saturation while on CPB was challenging be...
Source: A&A Case Reports - September 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Fluoroscopy-Guided Transfacet Lumbar Epidural Steroid Injection for Symptomatic Synovial Cyst Treatment: A Case Report
We report the case of a patient with a right-sided L4 synovial cyst, which had been causing significant pain, who had a successful transfacet epidural steroid injection to rupture the cyst. Using fluoroscopy, the needle was advanced through the right L4 facet joint and the cyst was ruptured using saline. The needle was then advanced into the epidural space and a transfacet epidural steroid injection was done. The patient’s symptoms resolved. Repeat magnetic resonance imaging (MRI) done 2 years later showed no recurrence of the cyst. We discuss the role of transfacet epidural steroid injection in synovial cysts treatm...
Source: A&A Case Reports - September 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Retained Intrathecal Catheter in a Patient With Baastrup Disease
We present a case of an epidural catheter inadvertently placed in the intrathecal space. The catheter sheared on attempted removal. The computed tomography scan of the lumbar spine revealed hypertrophic spinous processes (Baastrup disease) and a retained catheter fragment located in the thecal sac at L3–L4, terminating at the anterior portion of the interspinous ligament at L4–L5. Proper precautions should be taken when removing neuraxial catheters to prevent this complication. (Source: A&A Case Reports)
Source: A&A Case Reports - September 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

A Case Report of Peripheral Nerve Stimulation for Acute Neuropathic Pain in Guillain-Barre Syndrome
We present a case of acute neuropathic pain in a 22-year-old man with GBS managed with percutaneous peripheral nerve stimulation (PNS). Following implantation of leads in the bilateral sciatic, femoral, and brachial plexus nerve distribution, the patient experienced significant pain reduction in both the upper and lower extremities. Analgesic and anxiolytic medications were reduced by 33% on the first day and by 78% on day 21. PNS is a minimally invasive, nonpharmacologic modality for treating acute neuropathic pain in GBS patients. (Source: A&A Case Reports)
Source: A&A Case Reports - September 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Transitioning From Intrathecal Hydromorphone to Sublingual Buprenorphine–Naloxone Through Microdosing: A Case Report
A 76-year-old woman with chronic noncancer pain and an intrathecal hydromorphone–bupivacaine pump was admitted for acute exacerbation of heart failure. Her pump was unable to be replaced due to medical comorbidities. She was unable to tolerate oral opioids due to ventilatory depression. Tapering hydromorphone resulted in opioid withdrawal due to physiological dependence. Microdosing of sublingual buprenorphine–naloxone was initiated while decreasing intrathecal hydromorphone. This successfully weaned the patient off intrathecal hydromorphone with adequate pain relief and prevented both opioid withdrawal and ven...
Source: A&A Case Reports - September 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Implantable Cardioverter-Defibrillator Shock Delivered During Electroconvulsive Therapy Despite Magnet Application: A Case Report
Electroconvulsive therapy (ECT) in a patient with an implantable cardioverter-defibrillator (ICD) presents challenges to anesthesiologists. We encountered a patient who received an inappropriate shock during ECT despite magnet application. The phenomenon provides insight into how ICDs work—how they can inappropriately detect ECT stimulation and how they deliver antitachycardia therapy. We illuminate issues related to using magnets, discuss risks associated with inappropriate ICD therapy, and provide guidance for ICD management during ECT. (Source: A&A Case Reports)
Source: A&A Case Reports - September 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Electromagnetic Interference With an Underbody Dispersive Electrode in a Patient With an Implantable Cardioverter-Defibrillator Undergoing Noncardiac Surgery: A Case Report
We present a case in which an underbody electrode was used, and EMI occurred even though the surgical site was inferior to the umbilicus. Since little is known about EMI risk with underbody electrodes, practitioners should be wary of their use in CIED patients undergoing surgery until more information is available. (Source: A&A Case Reports)
Source: A&A Case Reports - September 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Inappropriate Defibrillator Shocks During Cervical Medial Branch Radiofrequency Ablation: A Case Report
A 52-year-old woman with a history of cervical spondylosis, nonischemic dilated cardiomyopathy, and complete heart block with implantation of a cardiac resynchronization therapy defibrillator (Inogen XR, Boston Scientific, Natick, MA) underwent bilateral fluoroscopy-guided radiofrequency ablation of the medial branch nerves at C4, C5, and C6 levels at an ambulatory surgery center. After completion of the seemingly routine procedure, several alerts, including 1 inappropriate shock, were received via Boston Scientific’s remote monitoring system. Tracings also showed that pacing inhibition occurred. When performing radi...
Source: A&A Case Reports - September 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Misadventures With Implantable Cardioverter-Defibrillators: The Hits Just Keep on Coming
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - September 1, 2020 Category: Anesthesiology Tags: Editorial Source Type: research

Lung Ultrasound in Thoracic Surgery: Confirming Placement of a Pediatric Right Double-Lumen Tube
In the recent decades, flexible bronchoscopy has replaced lung auscultation to confirm more precisely the placement of a double-lumen endotracheal tube (DLT) for thoracic surgery. However, bronchoscopes are costly and not always available. Lung ultrasound has been described in the literature as an alternative to confirm left DLT placement and lung isolation. In this case report, we describe a pediatric thoracic case in which lung ultrasound was utilized to confirm correct placement of a right-sided DLT. (Source: A&A Case Reports)
Source: A&A Case Reports - August 1, 2020 Category: Anesthesiology Tags: Diagnostic Ultrasound Rounds Source Type: research

Intraoperative Diagnosis of Subaortic Stenosis in a Young Patient Scheduled for Elective Aortic Valve Replacement
A 25-year-old patient with a history of aortic stenosis due to presumed bicuspid aortic valve presented for elective aortic valve replacement. Intraoperative transesophageal echocardiography (TEE) revealed a trileaflet aortic valve but detected the presence of a subvalvular membrane. Multiplanar reconstruction of the 3-dimensional (3D) dataset measured a cross-sectional area of 0.8 cm2 at the level of this subvalvular membrane. Successful resection resulted in relief of the obstruction. Compared with preoperative transthoracic echocardiography, TEE was able to correctly characterize the nature of the stenosis with a...
Source: A&A Case Reports - August 1, 2020 Category: Anesthesiology Tags: Echo Rounds Source Type: research

Intraoperative Transesophageal Echocardiography in a Rare Case of Situs Inversus, Levocardia, and Congenitally Corrected Transposition of Great Arteries: A Sequential Segmental Analysis
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - August 1, 2020 Category: Anesthesiology Tags: Echo Rounds Source Type: research

Documenting Difficult Intubation in the Context of Video Laryngoscopy: Results From a Clinician Survey
Ambiguity in defining difficult intubation involving video laryngoscopy (VL) may pose potential risks to patients. To improve airway documentation practices, we surveyed anesthesia providers on their difficult intubation interpretations and VL use. Of clinicians surveyed, 66.4% considered 3 or more intubation attempts difficult, while only 10.9% considered Cormack-Lehane grade 3–4 view with direct laryngoscopy difficult. Moreover, over 50% would choose VL as their first-line device for anticipated difficult intubation. These results suggest that clinicians inconsistently interpret difficult intubations, especially in...
Source: A&A Case Reports - August 1, 2020 Category: Anesthesiology Tags: Innovation Source Type: research

Focused Cardiac Ultrasound and the Periresuscitative Period: A Case Series of Resident-Performed Echocardiographic Assessment Using Subcostal-Only View in Advanced Life Support
When incorporated into the 10-second pulse/rhythm check of the advanced life support (ALS) protocol, focused cardiac ultrasound is a useful adjunct to cardiopulmonary resuscitation. In this case series, we demonstrated the feasibility of echocardiographic assessment using subcostal-only view in ALS (EASy-ALS) performed by anesthesiology residents during the periresuscitative period after structured training. Residents obtained diagnostic quality images in 100% of the self-reported cases, which enabled them to identify cardiac motion and potentially reversible causes of hemodynamic instability. Implementation of EASy-ALS in...
Source: A&A Case Reports - August 1, 2020 Category: Anesthesiology Tags: Case Series Source Type: research

Lumbar Dorsal Root Ganglion Stimulation Lead Placement Using an Outside-In Technique in 4 Patients With Failed Back Surgery Syndrome: A Case Series
We describe an “outside-in” placement technique of DRG-S leads in 4 patients with histories of multiple lumbar surgeries, which made the traditional anterograde placement not feasible. At long-term follow-up, the patients experienced substantial pain relief and improvement in quality of life, with no complications. The outside-in lead placement technique may be an efficacious alternative to the traditional techniques in patients with anomalous anatomy from prior surgery. (Source: A&A Case Reports)
Source: A&A Case Reports - August 1, 2020 Category: Anesthesiology Tags: Case Series Source Type: research

Epidural Blood Patch for Postdural Puncture Headache in a Patient With Coronavirus Disease 2019: A Case Report
The safety of epidural blood patch in patients with coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is unknown. Here, we report a single case of epidural blood patch to treat a postdural puncture headache in a woman after spinal anesthesia for cesarean delivery. The patient’s headache was relieved, and she did not develop any other neurological symptoms. (Source: A&A Case Reports)
Source: A&A Case Reports - August 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Spontaneous Spread of Limb Complex Regional Pain Syndrome to the Ipsilateral Face With Ultimate Corneal Abrasion: A Case Report
Complex regional pain syndrome (CRPS) has the potential to spread from the initial site to distant areas of the body. However, there is a paucity of data reporting the patterns and underlying cause of the spread. This case describes spontaneous, ipsilateral spread of CRPS from the right lower extremity to the orbit, leading to corneal abrasion. (Source: A&A Case Reports)
Source: A&A Case Reports - August 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Complex Glycerol Kinase Deficiency (Xp21 Deletion Syndrome): A Case Report of a Contiguous Gene Disorder Necessitating Creative Anesthetic Planning
We report a case of Xp21 deletion syndrome, a contiguous gene syndrome associating glycerol kinase deficiency, Duchenne muscular dystrophy, and congenital adrenal hypoplasia. This results in a contraindication to the use of all halogenated agents and of propofol. We used regional anesthesia combined with dexmedetomidine and ketamine. Previously, the patient had received inadvertently a propofol-based total intravenous anesthesia (TIVA) with no clinical side effects. We were unfortunately unable to document the metabolic consequences of this glycerol load. We suggest that if propofol is deemed necessary in such cases, it sh...
Source: A&A Case Reports - August 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

A Tale of 2 Tubes for Emergency Management of Airway Obstruction From an Anterior Mediastinal Mass: A Case Report
Anterior mediastinal masses are challenging. As induction of general anesthesia may result in complete airway obstruction or hemodynamic collapse, maintaining spontaneous ventilation and advancing the endotracheal tube (ETT) distal to the mass are recommended. We discuss the emergency management of an anterior mediastinal mass-induced near-complete airway obstruction at the carina. Despite maintaining spontaneous ventilation, airway obstruction persisted following placement of the ETT proximal to the obstruction. After advancing the ETT into the right mainstem bronchus distal to the mass, hypoxemia persisted, prompting pla...
Source: A&A Case Reports - August 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

An Unresponsive Patient in Postanesthesia Care Unit: A Case Report of an Unusual Diagnosis for a Common Problem
An unresponsive patient in the postoperative period is a serious complication that can be caused by anesthetics. However, nonanesthetic causes should also be considered. In this case report, we present an unresponsive postoperative patient diagnosed with possible psychosomatic catatonia. We further describe a systematic approach to the unresponsive patient in the postanesthesia care unit (PACU). While not an uncommon occurrence, catatonia is a complex psychomotor syndrome that can be difficult to diagnose; however, catatonia should be considered in unresponsive postoperative patients. (Source: A&A Case Reports)
Source: A&A Case Reports - August 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Perioperative Management of a Patient With Decompensated Upper Limb Arteriovenous Malformation Undergoing Shoulder Disarticulation: A Case Report
We present the challenges encountered in the perioperative care of a 23-year-old man with high output cardiac failure, gangrenous hand, and severe chronic pain undergoing shoulder disarticulation for a high-flow complex AVM of the upper limb. (Source: A&A Case Reports)
Source: A&A Case Reports - August 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Perioperative Echocardiography to Confirm Correct Central Venous Catheter Placement: A Case Report
We report a case in which a right internal jugular CVC was inserted under ultrasound guidance and was found to be malpositioned after sternotomy into an anomalous posterior thymic vein. Therefore, we recommend confirming the correct position of CVC with transesophageal echocardiography if such is indicated for the perioperative period and emphasize the importance of a correct J-tip of the guidewire when placing a CVC. (Source: A&A Case Reports)
Source: A&A Case Reports - August 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Ventilator Failure Following Cardiopulmonary Bypass: A Case Report
We present 3 cardiothoracic surgery cases during which the Drager Perseus A500 anesthesia machine and the iNOmax Delivery System were used concurrently, resulting in ventilator failures while attempting to separate from cardiopulmonary bypass (CPB). The failure was found to be caused by the iNOmax Delivery System sampling line, where negative pressure on the Perseus A500 breathing circuit precipitated a ventilator failure when the machine was brought out of “standby mode.” To our knowledge, there is no discussion of this interaction in the literature, and we find this to be an important issue for patient safety...
Source: A&A Case Reports - August 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Saddle Up: Anticoagulation for Extracorporeal Membrane Oxygenation in a Pulmonary Embolism and Ischemic Stroke—A Case Report
This case describes an anticoagulation strategy in a postpartum patient on venoarterial extracorporeal membrane oxygenation (VA ECMO) for a pulmonary embolism (PE) with a concurrent ischemic stroke. After receiving systemic lysis, the patient had impending cardiovascular collapse, right heart strain, worsening clinical picture, prompting VA ECMO cannulation and subsequent cautious management of the patient’s anticoagulation. There have been no similar cases published describing an ECMO anticoagulation strategy and management for this complex clinical situation. By withholding a heparin bolus and delaying initiation o...
Source: A&A Case Reports - August 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Anesthesia Management for Cesarean Delivery in a Woman With Aromatic l-Amino Acid Decarboxylase Deficiency: A Case Report
We report the successful management of anesthesia in a 26-year-old pregnant woman presenting with a mild phenotype of AADCD. Neuraxial anesthesia was administered, as she had not developed complications previously. Thus, neuraxial anesthesia can also be used safely for a cesarean delivery with appropriate anticipation of potential autonomic disturbances and lack of adrenergic neurotransmission. (Source: A&A Case Reports)
Source: A&A Case Reports - August 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research

Abrupt Exacerbation of Atrial Functional Mitral Regurgitation During Emergence From General Anesthesia Following Transcatheter Aortic Valve Replacement
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - July 1, 2020 Category: Anesthesiology Tags: Echo Rounds Source Type: research