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 hemodynamic ...
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 or sedative agents aside f...
Source: A&A Case Reports - May 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
