Unusual Manifestations of the Trigeminocardiac Reflex During Awake Craniotomy: A Case Report and Review of the Literature
The trigeminocardiac reflex (TCR) is triggered by stimulation of a branch of the trigeminal nerve and results in vagally mediated bradycardia, hypotension, apnea, and gastrointestinal hypermotility. In the operating theatre, patients susceptible to TCR are typically under general anesthesia; thus, cardiac abnormalities are the most common manifestation. Our case highlights the less common intraoperative manifestations of gastric hypermotility and apnea in a patient undergoing awake craniotomy for tumor resection. Prompt recognition, removal of stimuli, and airway management prevented catastrophic complications while facili...
Source: A&A Case Reports - August 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Peripartum Diagnosis of Currarino Syndrome With Anterior Sacral Meningocele: A Case Report
We present a case of Currarino syndrome; an autosomal dominant triad of agenesis of the sacrum, anterior sacral meningocele (ASM) with sacral teratomas, and anorectal stenosis; diagnosed during pregnancy; and the subsequent anesthetic considerations. The location, size, and risk of rupture of the ASM can create obstacles to delivery. Eligibility for neuraxial anesthesia should be made on a case-by-case basis with risk-benefit analysis, and deficits should be documented allowing prompt identification and intervention should complications arise. Multidisciplinary team coordination is vital to help facilitate maternal safety....
Source: A&A Case Reports - August 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 - July 1, 2021 Category: Anesthesiology Tags: Letter to the Editor Source Type: research
Comments on: “Massive Leak in CO2 Absorber of Perseus A500 Did Not Inhibit Mechanical Ventilation But Manual Bag Ventilation: A Case Report with Experimental Reproduction”
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - July 1, 2021 Category: Anesthesiology Tags: Letter to the Editor Source Type: research
Multilevel Erector Spinae Plane Block: Another Piece of the Jigsaw
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - July 1, 2021 Category: Anesthesiology Tags: Letter to the Editor Source Type: research
Transesophageal Echocardiographic Assessment of Left Ventricular Outflow Tract Area by 2-Dimensional Diameter, Biplane Planimetry, and 3-Dimensional Planimetry and Its Implications: “Thinking Outside the Circle”
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - July 1, 2021 Category: Anesthesiology Tags: Echo Didactics Source Type: research
Perioperative Pulmonary Optimization With Average Volume-Assured Pressure Support of a Pediatric Patient With Ullrich Congenital Muscular Dystrophy: A Case Report
Patients with preexisting respiratory compromise are at risk for perioperative respiratory failure. Adult literature has shown benefit with prophylactic postoperative use of noninvasive mechanical ventilation (NIMV). While pediatric literature has documented the increasing use of postoperative NIMV, there is no literature on prophylactic preoperative NIMV in patients with preexisting respiratory compromise. Further, surgical literature does not address preoperative prophylactic use of NIMV, as well as use of the newest modality of NIMV, average volume-assured pressure support (AVAPS). Here, we describe the first report of ...
Source: A&A Case Reports - July 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Anesthetic Considerations in Alström Syndrome: A Case Report
This report highlights perioperative challenges in the management of this condition in the emergency setting. (Source: A&A Case Reports)
Source: A&A Case Reports - July 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Transesophageal Echocardiography in Patients With Magnetic Gastroesophageal Reflux Devices: A Report of 2 Cases
Magnetic gastroesophageal reflux devices are becoming a common treatment option for reflux refractory to medical therapy. These devices are inserted laparoscopically with successful outcomes; however, patients may still complain of dysphagia after implantation. Echocardiographers may be hesitant to perform transesophageal echocardiography (TEE) in these patients as esophageal surgery and dysphagia represent relative contraindications to performing TEE. However, we present 2 cases where intraoperative TEE was performed in patients with reflux devices without complication or image degradation. The described cases, in additio...
Source: A&A Case Reports - July 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
A Unique Treatment for Compartment Syndrome After Intravenous Catheter Extravasation: A Case Report
Intravenous cannulation is performed on nearly every patient presenting for an anesthetic. Complications of the procedure include infiltration and extravasation, which can have a varied impact on the patient. Here, we present a case of severe intravenous (IV) extravasation, resulting in compartment syndrome of the hand. Rather than treating the compartment syndrome with fasciotomies as is standard, we utilized compression therapy via an Esmarch surgical dressing wrapped distal to proximal on the effected limb, which resulted in marked decrease in swelling and return of perfusion to the hand. (Source: A&A Case Reports)
Source: A&A Case Reports - July 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Postoperative Thyroid Storm After Evacuation of a Complete Hydatidiform Mole: A Case Report
We present a case of complete molar pregnancy with hyperthyroidism that was not identified or treated before surgical evacuation of uterine contents. Untreated hyperthyroidism preoperatively led to unanticipated thyroid storm immediately after emergence from anesthesia. It is important for anesthesia providers to recognize the link between gestational trophoblastic disease and thyrotoxicosis, and appreciate the severe consequences than can occur if left untreated. Anesthesia providers should strongly consider preoperative consultation and treatment. Being prepared to treat intraoperative symptoms and thyroid storm is param...
Source: A&A Case Reports - July 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Refractory Severe Laryngospam During Rapid Sequence Induction: A Case Report
We report a case of severe laryngospasm following rapid sequence induction in an adult requiring an emergency neurosurgical procedure. Laryngospasm occurred despite deep anesthesia with ketamine and neuromuscular blockade with succinylcholine. Several intubation attempts failed. Therefore, 2 hypotheses are considered: succinylcholine resistance and ketamine-induced laryngospasm. To our knowledge, this is the first description of laryngospasm occurring despite deep anesthesia and neuromuscular blockade. An idiosyncratic effect of ketamine may be involved, although this phenomenon has not yet been studied. (Source: A&A Case Reports)
Source: A&A Case Reports - July 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Paradoxical Platypnea-Orthodeoxia Syndrome Induced by Patent Foramen Ovale and Highly Tortuous Descending Thoracic Aorta: A Case Report
Perioperative hypoxemia is common in patients with aortic dissection. Platypnea-orthodeoxia syndrome (POS), in which hypoxemia in the upright position improves with relocating to a recumbent position, can be a rare cause of hypoxemia. This syndrome is more likely to occur in patients with an intracardiac shunt and aortic malformation. Hypoxemic symptoms present in our patient were paradoxical to those of common POS due to the highly tortuous descending thoracic aorta (DTA) and Eustachian valve. Therefore, establishing the diagnosis was difficult. POS should be suspected when patients with high tortuosity and curvature of D...
Source: A&A Case Reports - July 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Cryoablation of an Inguinal Angiomyomatous Hamartoma: A Case Report
We present a follow-up case report describing this patient’s sustained pain relief after cryoablation therapy. (Source: A&A Case Reports)
Source: A&A Case Reports - July 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Rocuronium-Induced Dilated Nonreactive Pupils in a Patient With Coronavirus Disease 2019: A Case Report
We report the clinical case of a patient with coronavirus disease 2019 (COVID-19) who had recently undergone neurosurgery and presented with dilated nonreactive pupils during continuous rocuronium infusion, which was reversible with the suspension of the drug. Both the neurosurgical procedure and possible disruption of the blood–brain barrier due to COVID-19 infection may have led to the action of rocuronium in the central nervous system (CNS). Thus, clinicians must remember that neuromuscular blocking agents (NMBAs) can cause dilated nonreactive pupils in patients with COVID-19. (Source: A&A Case Reports)
Source: A&A Case Reports - July 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
