In Response
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - June 1, 2021 Category: Anesthesiology Tags: Response Letter to the Editor Source Type: research

Comments on: “Postoperative Hyperthermia and Hemodynamic Instability in a Suspected Malignant Hyperthermia Susceptible Patient: A Case Report”
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - June 1, 2021 Category: Anesthesiology Tags: Letter to the Editor Source Type: research

Formation of an Anesthesiology Residency Mentoring Program Using a Mentee-Driven Approach
This report details the program design and early observations. (Source: A&A Case Reports)
Source: A&A Case Reports - June 1, 2021 Category: Anesthesiology Tags: Educational Tool Source Type: research

Perioperative Code Status Discussions: How Are We Doing?
We present solutions to improve CSD documentation, including refining perioperative workflows, simplifying code status choices, optimizing electronic health record order entry, and a supplementary consent form to facilitate code status review. (Source: A&A Case Reports)
Source: A&A Case Reports - June 1, 2021 Category: Anesthesiology Tags: Innovation Source Type: research

High Peak Inspiratory Pressures After a Change of Heat and Moisture Exchangers: A Case Series
We describe 4 cases of gradually increasing PIPs from progressive HME obstruction that occurred within 6 months of an institutional change to a newer model. HME obstruction should be considered when PIPs are elevated. Alternative heat and moisture preservation strategies should be contemplated, as HMEs increase airflow resistance and add another point of possible malfunction. (Source: A&A Case Reports)
Source: A&A Case Reports - June 1, 2021 Category: Anesthesiology Tags: Case Series Source Type: research

Postprandial Hypotension in the Intensive Care Unit Due To Portal Hypertension and Coronavirus Disease 2019: A Case Report
A 49-year-old man with cirrhosis and portal hypertension was admitted for acute respiratory distress syndrome secondary to coronavirus disease 2019 (COVID-19) pneumonia. His course was complicated by postprandial hypotension (PPH)—episodic hemodynamic collapse that occurred minutes after enteral administration of medications or fluids. Octreotide, which reduces splanchnic pooling and can treat PPH, successfully prevented ongoing events. PPH is associated with mortality in the outpatient setting, and at-risk patients include the elderly and those with autonomic dysfunction, including those with COVID-19. Portal hypert...
Source: A&A Case Reports - June 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

Prevention of Perioperative Abdominal Migraine in a Patient Undergoing Spinal Fusion: A Case Report
We describe a 74-year-old patient with progressively worsening back pain, severe neurogenic claudication, and a history of opioid-triggered abdominal migraine. As a precautionary measure, a perioperative opioid-sparing treatment plan was devised to prevent abdominal migraine while the patient underwent elective lumbar fusion surgery. Opioid-sparing treatment plans may enable similar patients to undergo surgery without experiencing perioperative abdominal migraines. (Source: A&A Case Reports)
Source: A&A Case Reports - June 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

Paraspinous Quadratus Lumborum Block: A New Analgesic Option for a Thigh Sarcoma Resection With Reconstruction—A Case Report
We present a case of a patient undergoing a resection of a sarcoma in the lower limb with an immediate reconstruction with a pedicled vertical designed deep inferior epigastric perforator flap, in whom a successful paraspinous transmuscular quadratus lumborum block for postoperative analgesia was performed. (Source: A&A Case Reports)
Source: A&A Case Reports - June 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

Feasibility of Combining Nerve Stimulation and Local Anesthetic Infusion to Treat Acute Postamputation Pain: A Case Report of a Hybrid Technique
We describe a novel pain management approach in a 56-year-old woman with episodes of poorly controlled pain following below-knee amputation despite a multimodal analgesic regimen with continuous sciatic nerve block. Effective analgesia was observed during those episodes when the nerve block catheter was briefly stimulated at low frequency using a nerve stimulator designed for regional anesthesia procedural guidance. This case report explains the utilization and rationale of this hybrid technique of combined peripheral nerve stimulation and locoregional analgesia via perineural nerve block catheters to augment analgesia. (S...
Source: A&A Case Reports - June 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

A Patient With Kearns Sayre Syndrome and Charcot-Marie-Tooth for Supraventricular Tachycardia Ablation: A Case Report
We report a 52-year-old man diagnosed with variants of KSS and CMT presenting for supraventricular tachycardia (SVT) ablation. This is the first report of successful perioperative management of a general anesthetic in a patient with both KSS and CMT. (Source: A&A Case Reports)
Source: A&A Case Reports - June 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

Pregnancy With Large Arteriovenous Malformation of Tongue: Anesthetic Challenges and Conduct
A pregnant woman with large intraoral arteriovenous malformation of tongue obliterating the oral cavity presented for elective cesarean delivery shortly after experiencing spontaneous, large-volume, oral bleeding. This case report describes the unconventional method of securing the airway for ensuring perioperative airway protection and the anesthetic management of the case (Source: A&A Case Reports)
Source: A&A Case Reports - June 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

Transient Neurological Dysfunction and Intracranial Hypertension After Tourniquet Deflation in a Patient With a Head Injury: A Case Report
We report a case of transient neurological dysfunction and intracranial hypertension after tourniquet deflation in a 15-year-old patient with a head injury. Intracranial hypertension under general anesthesia was diagnosed based on bradyarrhythmia and elevated ultrasonographic optic nerve sheath diameter as compared to preoperative values. (Source: A&A Case Reports)
Source: A&A Case Reports - June 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

Chest Wall Regional Anesthesia for Modified Radical Mastectomy and Axillary Lymph Node Dissection: A Case Report
We describe the use of chest wall fascial plane blocks as the primary anesthetic, combined with high-flow humidified nasal oxygen and low-dose propofol sedation, in a patient with complex comorbidities presenting for modified radical mastectomy and axillary lymph node dissection. (Source: A&A Case Reports)
Source: A&A Case Reports - June 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

Inferior Vena Cava Leiomyosarcoma With Extension to Right Atrium in a Parturient at 30 Weeks of Gestation: A Case Report
Primary leiomyosarcomas of the inferior vena cava (IVC) are rare sarcomas, none of which have been described in literature during a third-trimester pregnancy. Here, we describe the complex care of a patient at 30 weeks of gestation who presented to her obstetrician with shortness of breath and lower extremity swelling. She was found to have a 5.0 × 5.0 × 13 cm heterogeneous mass of her IVC, ultimately diagnosed as a leiomyosarcoma. She underwent a cesarean delivery under combined spinal epidural and a subsequent tumor resection and IVC reconstruction requiring multidisciplinary surgical and anesthetic ca...
Source: A&A Case Reports - June 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

Alternative Implantation Site of Intrathecal Pump in the Submuscular Plane of the Pectoralis Major Muscle: A Case Report
An intrathecal drug delivery system (IDDS) has been widely utilized in the management of chronic pain and spasticity when oral pharmacologic agents are deemed ineffective. Typically, intrathecal pumps are implanted in the abdominal region; however, previous case reports have described nontraditional pump implantation sites, such as anterior thigh, gluteal region, and iliac fossa. Adding to the growing literature of alternative implantation sites, this case report discusses the implantation of the pump into the submuscular plane of the pectoralis major muscle and reviews the advantages and disadvantages of this location. (S...
Source: A&A Case Reports - June 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

Mouthpiece Noninvasive Ventilation in a Patient With Traumatic Cervical Spinal Cord Injury: A Case Report
We present a case of a young man who fell off a platform and sustained a traumatic third and fourth cervical vertebrae (C3/4) fracture dislocation with bilateral facet dislocation, in whom a trial of mouthpiece NIV was attempted. We discuss the issues surrounding this method of ventilation in ventilator-dependent patients. (Source: A&A Case Reports)
Source: A&A Case Reports - June 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

Development of an Automated Technology Platform for Preoperative Triage and Patient Preparation
A proof of concept study was conducted to implement an automated preoperative triage and preparation service with 2 components: (1) triage between preoperative visits and phone screens, and (2) delivery of preoperative instructions to patients. The study enrolled 2604 patients, of whom 75.7% completed the preoperative triage questionnaire and 47.6% were triaged to preoperative phone screens. For the preoperative preparation component, 90.8% of patients viewed surgery preparation instructions, and average patient satisfaction score was 9.3/10. An automated preoperative triage and preparation service can facilitate preoperat...
Source: A&A Case Reports - May 1, 2021 Category: Anesthesiology Tags: Innovation Source Type: research

Using Lean Six Sigma to Decrease Delivery Time of Blood Products to the Operating Room
This article describes LSS methods and their application in health care. We detail a successful quality improvement (QI) initiative in which we tested LSS tools to evaluate and enhance our institution’s blood product delivery to the operating room (OR). Incorporating LSS-driven changes resulted in a revised workflow, which decreased personnel workload and significantly reduced delivery time. We hope this article will encourage other health care institutions to integrate LSS strategies into their workflows. (Source: A&A Case Reports)
Source: A&A Case Reports - May 1, 2021 Category: Anesthesiology Tags: Innovation Source Type: research

The Difficult Airway Navigator: Development and Implementation of a Health Care System’s Approach to Difficult Airway Documentation Utilizing the Electronic Health Record
We describe this tool’s creation and implementation, which allows clinicians to readily review past airway information and efficiently create difficult airway notes, bedside signs, flags, and orders. (Source: A&A Case Reports)
Source: A&A Case Reports - May 1, 2021 Category: Anesthesiology Tags: Innovation Source Type: research

Prevalence of Preoperative Iron Deficiency Anemia: A Case Series Among Patients Undergoing Radical Cystectomy
Anemia occurs in a significant group of patients with bladder cancer before radical cystectomy. Iron deficiency is a readily identifiable cause of anemia, which can be treated before surgery. The proportion of patients with bladder cancer with iron deficiency anemia is unknown. Laboratory and clinical outcomes were collected on 47 consecutive patients presenting for radical cystectomy. Iron studies found 30% of patients had iron deficiency anemia. These findings present an opportunity to treat anemia before surgery, to reduce blood transfusions during radical cystectomy. (Source: A&A Case Reports)
Source: A&A Case Reports - May 1, 2021 Category: Anesthesiology Tags: Case Series Source Type: research

Quantitative Assessment of the Incidence of Persistent Orthostatic Hemodynamic Changes After Celiac Plexus Neurolysis: A Prospective Case Series
Celiac plexus neurolysis has been associated with orthostatic hypotension but has not been quantified prospectively or evaluated for persistence after the immediate postprocedural period. Our objective was to quantify persistent hemodynamic changes induced by celiac plexus neurolysis. In this case series of 16 patients with cancer, 8 (50%) had orthostatic hypotension alone, 3 (18.75%) developed an exaggerated postural heart rate increase (>30 beats per min), and 1 (6.25%) had both orthostatic hypotension and an increased heart rate. While the analgesic benefit of celiac plexus neurolysis is clear, the observed hemodynam...
Source: A&A Case Reports - May 1, 2021 Category: Anesthesiology Tags: Case Series Source Type: research

Anesthetic Management for Endovascular Treatment of Stroke in Patients With Coronavirus Disease 2019: A Case Series
A significant number of patients with coronavirus disease 2019 develop strokes with large vessel obstructions that may require endovascular treatment for revascularization. Our series focuses on periprocedural issues and the anesthetic management of these patients. We analyzed medical records of 5 patients with positive reverse transcription polymerase chain reaction tests for severe acute respiratory syndrome coronavirus 2 during their hospitalization who underwent endovascular treatment at our hospital between March and mid-June 2020. We found that our patients were different from the typical patients with ischemic strok...
Source: A&A Case Reports - May 1, 2021 Category: Anesthesiology Tags: Case Series Source Type: research

Preventing Severe Acute Respiratory Syndrome Coronavirus-2 Exhalation Upon Tracheal Extubation in the Intensive Care Unit: A Case Series
We describe the use of a disposable openable mask (Janus Mask, Biomedical Srl, Florence, Italy) that might limit aerosol generation in the periextubation phase of COVID-19 cardiac surgical patients. (Source: A&A Case Reports)
Source: A&A Case Reports - May 1, 2021 Category: Anesthesiology Tags: Case Series Source Type: research

Utilization of Low-Dose Naltrexone for Burning Mouth Syndrome: A Case Report
We describe a woman in her seventh decade with burning mouth syndrome that had been refractory to treatment for nearly a decade. Low-dose naltrexone has been reported to provide analgesia in central sensitization states and was successful in reducing pain severity in our patient. We conclude that low-dose naltrexone may be a therapeutic option for patients with burning mouth syndrome who are refractory to conventional therapies. (Source: A&A Case Reports)
Source: A&A Case Reports - May 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

Unusual Cause of Intraoperative Asystole During Thoracotomy: A Case Report
We report an unusual case of intraoperative asystole related to electrosurgical stimulation of the left vagus nerve that required cardiopulmonary resuscitation and cardiac massage. (Source: A&A Case Reports)
Source: A&A Case Reports - May 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

Appropriate Delivery of Antitachyarrhythmia Therapy Despite Magnet Placement Over Implanted Cardioverter-Defibrillator: A Case Report
We report a case in which magnet placement over an ICD failed to suspend tachyarrhythmia therapy because of imprecise magnet positioning. This case demonstrates the possibility for error when relying on a magnet to suspend tachyarrhythmia therapies. (Source: A&A Case Reports)
Source: A&A Case Reports - May 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

Regional Anesthesia to the Rescue: Phrenic Nerve Block to Prevent Wound Dehiscence From Intractable Hiccups—A Case Report
Increased intra-abdominal pressure (IAP) following large abdominal surgeries can lead to postoperative complications, including wound dehiscence and surgical reoperation. Numerous factors can contribute to increased postoperative IAP, and intractable hiccups have been implicated as a culprit. Different treatment modalities have been widely used with variable success in addressing intractable hiccups. Here, we present a case in which postoperative hiccups leading to wound dehiscence and reoperation were successfully treated with an indwelling phrenic nerve catheter. Following placement, a significant reduction in hiccup sev...
Source: A&A Case Reports - May 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

Atypical Hemolytic-Uremic Syndrome Following Obstetric Hemorrhage in the Setting of Fetal Demise and Placenta Accreta: A Case Report
Multiple disease processes can contribute to coagulopathy in the setting of intrauterine fetal demise. A 34-year-old woman with multiple prior uterine surgeries presented for dilation and evacuation of a fetal demise at 17 weeks. Her case was complicated by significant hemorrhage and coagulopathy requiring massive transfusion and hysterectomy. She developed atypical hemolytic-uremic syndrome postoperatively. Pathology identified a focal placenta accreta. While not known to present together, fetal demise, placenta accreta, and atypical hemolytic-uremic syndrome can occur in the same patient with an overlapping presentation....
Source: A&A Case Reports - May 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

Severe Hyponatremia and Seizure From Peripheral Infusion of Norepinephrine Diluted in Dextrose 5% in Water: A Case Report
We describe a case of severe hyponatremia and seizure resulting from administration of norepinephrine concentrated at 4 μg/mL in dextrose 5% in water. After the incident, the institutional policy changed to recommend normal saline as the default diluent for peripheral norepinephrine, with a more concentrated option available. The incident also informed similar guidelines at other hospitals. (Source: A&A Case Reports)
Source: A&A Case Reports - May 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

Remimazolam Tolerance in Long-term Benzodiazepine Users: A Case Report of 2 Cases
A 60-year-old woman with a 5-year history of anxiolytic use, a diazepam-equivalent daily dose of 15 mg, was scheduled for esophageal stent removal. She was given remimazolam (0.5 mg/kg) but remained fully alert. She only lost consciousness with propofol (40 mg). A 61-year-old man with a 1-year history of anxiolytic use, diazepam-equivalent daily dose of 20 mg, was scheduled for hand tumor resection. He was given remimazolam (0.3 mg/kg) but remained fully alert. He only lost consciousness after desflurane inhalation. In a patient with a history of long-term benzodiazepine use, anesthetic o...
Source: A&A Case Reports - May 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

Endotracheal Intubation in a Difficult Neonatal Airway: A Case Report of a 16-Gauge Intravenous Catheter for Use as an Intubating Stylet
We present the use of a 16-gauge intravenous catheter as an intubating stylet for a 2.0-millimeter endotracheal tube in the management of a difficult airway in the neonatal intensive care unit. (Source: A&A Case Reports)
Source: A&A Case Reports - May 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

Intrasacral Meningocele Complicating Caudal Analgesia in a 6-Year-Old Child After 3 Previous Uneventful Caudals: A Case Report
A 6-year-old male undergoing bilateral hydrocelectomy was to receive caudal analgesia after induction of general anesthesia. After insertion of the caudal needle, cerebrospinal fluid was unexpectedly aspirated and the caudal was abandoned. The surgeon performed bilateral ilioinguinal nerve blocks just before incision. Surgery was uneventful. The patient had difficulty ambulating postoperatively, and a detailed neurologic examination revealed quadriceps weakness. A lumbosacral magnetic resonance imaging (MRI) revealed a sacral meningocele. By the next morning, quadriceps function had returned, and he was ambulating normally...
Source: A&A Case Reports - May 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

Puerperium Stroke and Subsequent Tissue-Type Plasminogen Activator–Induced Hemorrhage: A Case Report
We report a case of ischemic stroke in an apparently healthy 35-year-old gravida 2 para 1 who was treated with tissue-type plasminogen activator (tPA) 9 hours after vaginal delivery that resulted in severe hemorrhage. Limited data suggest use of thrombolytics in pregnancy is safe, but there is a paucity of evidence assessing their use immediately postpartum. We describe successful combination of tPA with endovascular mechanical thrombectomy (EMT) for treatment of postpartum stroke, which was followed by extensive uterine bleeding. (Source: A&A Case Reports)
Source: A&A Case Reports - May 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

Unrecognized Postoperative Opioid-Induced Movement Disorder: A Case Report
A 22-year-old man, with a medical history significant for posttraumatic stress disorder and chronic pain, underwent ankle surgery at the United States Naval Hospital, Yokosuka, Japan. His immediate postoperative course was complicated by episodic muscle rigidity, necessitating admission for diagnostic evaluation. The differential was necessarily broad and included local anesthetic toxicity, medication mediated effect, seizures, serotonin syndrome, and malignant hyperthermia. Cultural and systemic differences in patient care delivery at a Japanese hospital helped to elucidate the mechanism. This case highlights cultural dif...
Source: A&A Case Reports - May 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

Next-Generation Sequencing–Based Decision Support for Intensivists in Difficult-to-Diagnose Disease States: A Case Report of Invasive Cerebral Aspergillosis
Aspergillus spp. are widespread environmental pathogens that can induce invasive aspergillosis, especially in immunocompromised patients. An 86-year-old female patient presented with a rare case of invasive cerebral aspergillosis. The aspergilloma invaded the intracranial region originating from the ethmoidal sinus and the orbital apex. In contrast to routine diagnostic procedures, next-generation sequencing (NGS) was able to identify the fungal pathogen in the cerebrospinal fluid as well as in plasma samples, supporting the biopsy-based diagnosis of invasive cerebral aspergillosis. Therefore, NGS-based diagnostics may be ...
Source: A&A Case Reports - May 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

Nasopharyngeal Airway Causing Partial Tracheal Obstruction During an Awake Nasotracheal Fiberoptic Intubation: A Case Report
We describe a case where this nasopharyngeal airway was inadvertently advanced with the bronchoscope and led to partial tracheal obstruction. To our knowledge, this represents the first reported case of this mishap. Aspiration of the nasopharyngeal airway can lead to complete airway obstruction and devastating consequences. Simple techniques such as attaching a hemostat or using an assistant to hold on to the nasopharyngeal airway may prevent this occurrence. (Source: A&A Case Reports)
Source: A&A Case Reports - May 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

Goldenhar Syndrome With Ankylosis of the Temporomandibular Joint: A Case Report
Goldenhar syndrome, or oculoauriculovertebral dysplasia, represents approximately 10% of craniofacial microsomia anomalies. These patients have a variety of clinical features that are relevant to anesthesia providers, including a high-arched palate, mandibular hypoplasia, micrognathia, and temporomandibular joint (TMJ) malformation. The oral manifestations of Goldenhar syndrome range from malocclusion to complex TMJ involvement. Outside of the dental and oral surgery literature, the potential for TMJ ankylosis in Goldenhar patients is seldom emphasized. TMJ ankylosis impacts airway management, and anesthesia providers must...
Source: A&A Case Reports - May 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

Alternative Technique for Difficult Epidural Needle Placement: A Case Report
We report a case of difficult epidural needle placement in an elderly patient scheduled for bilateral total knee replacement (TKR). We attempted epidural needle placement many times without success. However, when a modified technique was used, the epidural space was identified easily and confirmed, the epidural catheter was inserted and fixed, and the postoperative epidural analgesia was effective. (Source: A&A Case Reports)
Source: A&A Case Reports - May 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

In Response
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2021 Category: Anesthesiology Tags: Letter to the Editor Source Type: research

Peripheral Nerve Stimulation of Complex Upper Extremity Amputation Pain May Be Variable
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2021 Category: Anesthesiology Tags: Letter to the Editor Source Type: research

In Response
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2021 Category: Anesthesiology Tags: Letter to the Editor Source Type: research

Comments on “Continuous Pericapsular Nerve Group Block for Hip Surgery: A Case Series”
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2021 Category: Anesthesiology Tags: Letter to the Editor Source Type: research

Perioperative Management of Flecainide: A Problem-Based Learning Discussion
This article reviews the pharmacology of flecainide, describes problematic arrhythmias that may arise specifically during flecainide use, and offers recommendations for perioperative flecainide management. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2021 Category: Anesthesiology Tags: Problem-Based Learning Discussion Source Type: research

The Formulation of Cognitive Aids and a Systematic Approach to Emergency Front-of-Neck Access, Following a “Can’t Intubate, Can’t Oxygenate” Crisis in a Patient With Ankylosing Spondylitis
A patient with ankylosing spondylitis in a “can’t intubate, can’t oxygenate” situation was rescued with cannula cricothyrotomy and transtracheal jet oxygenation. The case revealed clinical and systematic weaknesses, leading to standardization and reorganization of our equipment. Prepackaged cannula cricothyrotomy sets were placed in standardized locations in the operating rooms in line with our institution’s “cannula first” policy. Cognitive aids specific to emergency front-of-neck access (eFONA) were created and placed strategically with the eFONA equipment to prompt and guide ope...
Source: A&A Case Reports - April 1, 2021 Category: Anesthesiology Tags: Educational Tool Source Type: research

Teaching Medical Students to Create Anesthetic Plans Using a Branched-Chain Learning Module
It is challenging to include medical students in the anesthetic decision-making process during their introductory clinical rotation in anesthesiology. Furthermore, the rotation is often too brief to even expose students to the variety inherent in anesthesia practice. We created a web-based, branched-chain learning module (BCLM) for medical students with alternate narratives and patient outcomes based on their anesthetic choices. In semistructured group interviews, students described how the BCLM met its educational objectives and gave constructive feedback on several ways to improve their experience with it, guiding the fu...
Source: A&A Case Reports - April 1, 2021 Category: Anesthesiology Tags: Educational Tool Source Type: research

A Primer for Pediatric Emergency Front-of-the-Neck Access
“Cannot intubate, cannot oxygenate” situations in healthy children are uncommon but are often associated with poor outcomes. Clinical assessment, anticipatory planning, and the use of algorithms can lessen the likelihood of untoward outcomes, but the common final pathway of many algorithms for a difficult pediatric airway involves obtaining emergency tracheal access. The airway practitioner must have the know-how and training needed to invasively secure the airway when confronted with this rare but potentially devastating emergency. We provide practitioners with an overview of pediatric emergency front-of-the-n...
Source: A&A Case Reports - April 1, 2021 Category: Anesthesiology Tags: Educational Tool Source Type: research

Improving Tolerance to Snorkel Mask Use as Alternative Personal Protective Equipment
Snorkel masks have become an option for personal protective equipment (PPE) due to the shortage of air filtration at least 95% of airborne particle (N95) masks as a result of the coronavirus disease 2019 (COVID-19) pandemic. We developed a 3D design of a triheaded adapter that connects a snorkel mask to 3 different National Institute for Occupational Safety and Health (NIOSH)–approved air filtration at least 99% of airborne particles (N99) filters with the aim of improving wearer comfort. We measured the resistance of the new triheaded adapter to be one-third the resistance of the single adapter. Interdepartmental su...
Source: A&A Case Reports - April 1, 2021 Category: Anesthesiology Tags: Innovation Source Type: research

Cryoneurolysis of Innervation to Sacroiliac Joints: Technical Description and Initial Results—A Case Series
In this report, we present 5 patients with SIJ-related pain and we describe the ultrasound-guided SIJ cryoneurolysis technique and its analgesic efficacy. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2021 Category: Anesthesiology Tags: Case Series Source Type: research

Sympathetic Blockade for the Management of Refractory Ventricular Tachycardia: A Case Report
A 64-year-old man with a history of nonischemic cardiomyopathy (NICM) presented with electrical storm (ES). Episodes of ventricular tachycardia (VT) persisted despite endocardial catheter ablations and exhaustive pharmacotherapy. We used alternating regional anesthesia techniques, left stellate ganglion block, and proximal intercostal block to reduce sympathetic input to the heart, resulting in a significant decrease in VT burden. By using alternating catheter locations, we were able to maintain continuous sympathetic blockade for 31 days and bridge the patient to a successful orthotopic heart transplant. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research

Key Pathogenic Factors in Coronavirus Disease 2019–Associated Coagulopathy and Acute Lung Injury Highlighted in a Patient With Copresentation of Acute Myelocytic Leukemia: A Case Report
We report a 53-year-old man presenting with acute leukemia and COVID-19 who developed thrombotic complications and acute respiratory distress syndrome. Multiple analyses, including rotational thromboelastometry and flow cytometry on blood and bronchoalveolar lavage, are reported to characterize coagulation and immune profiles. The patient developed chemotherapy-induced neutropenia that may have protected his lungs from granulocyte-driven hyperinflammatory acute lung injury. However, neutropenia also alters viral clearing, potentially enabling ongoing viral propagation. This case depicts a precarious equilibrium between leu...
Source: A&A Case Reports - April 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research