Necrotizing Soft Tissue Infection or Sweet Syndrome: Surgery Versus No Surgery?: A Case Report
The authors report a case of necrotizing Sweet syndrome in a 24-year-old transsexual male who presented with recurrent myonecrosis of the neck/upper chest. On index admission, computer tomography revealed gas and fat stranding of the sternocleidomastoid and pectoralis major muscle—findings suggestive of a necrotizing soft tissue infection. Despite debridement procedures and intravenous antibiotic therapy, myonecrosis of the affected areas persisted. Evaluation of tissue samples by dermatopathology revealed neutrophilic infiltration extending into the dermis and muscle necrosis, findings consistent with necrotizing Sw...
Source: A&A Case Reports - April 1, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Hypertensive Crisis During Norepinephrine Syringe Exchange: A Case Report
A 67-year critically ill patient suffered from a hypertensive crisis (200 mm Hg) because of a norepinephrine overdose. The overdose occurred when the clinician exchanged an almost-empty syringe and the syringe pump repeatedly reported an error. We hypothesized that an object between the plunger and the syringe driver may have caused the exertion of too much force on the syringe. Testing this hypothesis in vitro showed significant peak dosing errors (up to +572%) but moderate overdose (0.07 mL, +225%) if a clamp was used on the intravenous infusion line and a large overdose (0.8 mL, +2700%) if no clamp ...
Source: A&A Case Reports - April 1, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Delayed Anaphylaxis to Mammalian Meat Following Tick Exposure and Its Impact on Anesthetic Management for Cardiac Surgery: A Case Report
We present 3 patients with previous sensitization to meat protein following a tick bite with known allergic reactions to mammalian meat who presented for cardiac surgery involving exposure to potential allergens and discuss the perioperative management including possible prevention. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Anesthetic Management of a Tracheoesophageal Fistula in a Patient With a Large Uncorrected Aortopulmonary Window: A Case Report
We present the anesthetic management of a 1-day-old neonate with a postnatally diagnosed aortopulmonary window for correction of a TEF. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Retropharyngeal Perforation With an Esophageal Dilator: A Case Report
We present a case of retropharyngeal wall perforation resulting from esophageal dilator misplacement in a patient undergoing laparoscopic Heller myotomy and reconstruction. This case report demonstrates the importance of communication between surgery and anesthesiology teams during placement of devices into the oropharynx. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Mitral Inflow Obstruction Resulting From a Dilated Coronary Sinus: Role of Intraoperative Transesophageal Echocardiography in Diagnosis and Surgical Repair: A Case Report
We report 2 cases of supramitral obstruction where the intraoperative transesophageal echocardiography has refined the preoperative diagnosis and changed the course of surgical repair. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Postoperative Hemiplegic Migraine After a Laparoscopic Cholecystectomy: A Case Report
We report the case of a 35-year-old woman who developed severe right-sided hemiplegia and hemisensory loss shortly after emergence from general anesthesia for a laparoscopic cholecystectomy. Her medical history was significant for migraine with aura and a family history of transient hemiparesis thought to be a result of a transient ischemic attack. The patient’s deficits slowly resolved, and she was ultimately diagnosed with familial hemiplegic migraine after a negative workup for cerebrovascular accidents. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

The Role of Simulation in Planning Intraoperative Magnetic Resonance Imaging-Guided Neurosurgical Procedures: A Case Report
We present our experience with 2 cases of preprocedural simulation on healthy volunteers that were performed in the intraoperative magnetic resonance imaging suite. During one of the cases, we also simulated a scenario of sudden cardiac arrest. Such an approach helped us to refine the procedures and coordinate the work of different teams within the intraoperative magnetic resonance imaging suite as well as improve the quality of patient management. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Bilateral Congenital Iris Sphincter Agenesis Diagnosed After Massive Bleeding Episode During Repair of Aneurysmal Dilation of Patent Ductus Arteriosus: A Case Report
We report a rare case of an infant with both an aneurysmal dilation of the patent ductus arteriosus (PDA) and bilateral congenital iris sphincter agenesis. Her mydriasis without pupillary light reflex was first noted after a massive intraoperative bleeding episode during the PDA ligation. The assumption that the mydriasis was a sign of cerebral ischemia led to additional examinations and intensive medical therapies that in retrospect were unnecessary. This is the first reported case of combined aneurysmal dilation of a PDA and congenital iris sphincter agenesis in the anesthesia literature. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Anesthetic Management of a Patient With Antimuscle-Specific Kinase Antibody-Positive Myasthenia Gravis Undergoing an Open Cholecystectomy: A Case Report
Myasthenia gravis (MG) is an autoimmune disease characterized by the production of antibodies against the acetylcholine receptor, muscle-specific kinase (MuSK), or other proteins at the neuromuscular junction. MG with antibodies against MuSK (MuSK-MG) has been described recently. Here, we report the first case of anesthetic management of a patient with MuSK-MG undergoing an open cholecystectomy. In our case, propofol and remifentanil-based anesthesia were used for successful management without using muscle relaxants. Patients with MuSK-MG have predominantly ocular, bulbar, and respiratory symptoms that may increase the ris...
Source: A&A Case Reports - March 15, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

The Extraordinary Case of the Hungry Woman: Large Foreign Body Ingestion With Respiratory Arrest
Repeated ingestion of small objects has been previously reported in the psychiatric literature. We recently had a patient with repeated intentional foreign body ingestion syndrome who developed complete airway obstruction and cardiac arrest after ingesting a computer mouse tracking ball. We use our case to suggest a pathway that can be used for similar emergent airway problems. (Source: A&A Case Reports)
Source: A&A Case Reports - March 15, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Capnoperitoneum During Peroral Endoscopic Myotomy—Recognition and Management: A Case Report
We present a case in which gas accumulation in the abdomen during POEM had adverse effects on ventilation. Once the cause was recognized, needle decompression of the abdomen led to immediate improvement in ventilation. (Source: A&A Case Reports)
Source: A&A Case Reports - March 15, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Iatrogenic Cardiac Tamponade During Endovascular Aortic and Mesenteric Stent Grafting: A Case Report
The authors report a case of left ventricular perforation and cardiac tamponade in a patient undergoing endovascular aortic and mesenteric stent grafting. During the procedure, the anesthetist noticed a sudden increase in central venous pressure and a decrease in blood pressure. Cardiac tamponade was suspected and confirmed by transesophageal echocardiography. Pericardiotomy resulted only in temporary stabilization. Emergency sternotomy revealed left ventricular perforation. Both anesthetists and radiologists have to be aware of such rare but severe complications of interventional procedures. (Source: A&A Case Reports)
Source: A&A Case Reports - March 15, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

A Case Report: Establishing a Definitive Airway in a Trauma Patient With a King Laryngeal Tube In Situ in the Presence of a Closed Head Injury and Difficult Airway: “Between the Devil and the Deep Blue Sea”
We describe a novel fiberoptic, video laryngoscope-assisted approach to intubation in a difficult trauma airway with an in situ King Laryngeal Tube. (Source: A&A Case Reports)
Source: A&A Case Reports - March 15, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Fiberoptic-Guided Blue Rhino Dilator-Assisted Dilation of Postintubation Tracheal Stenosis: A Case Report About a Novel Technique
We describe a novel salvage modality for dilation of a symptomatic tracheal stenosis using a percutaneous tracheostomy dilator wherein rigid bronchoscopic dilation was not feasible and balloon tracheal dilation had failed. (Source: A&A Case Reports)
Source: A&A Case Reports - March 15, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Case Report of Serratus Plane Catheter for Pain Management in a Patient With Multiple Rib Fractures and an Inferior Scapular Fracture
We placed a superficial serratus anterior plane catheter in an elderly woman with dementia and elevated clotting times who presented with multiple rib fractures after a mechanical fall. She was not a surgical candidate, and treatment consisted of conservative management with physical therapy and pain control. She was not a candidate for a patient-controlled analgesia regimen because of her dementia. Given her elevated international normalized ratio, thoracic epidural and paravertebral analgesia was also contraindicated. We placed an ultrasound-guided serratus anterior plane catheter, allowing titratable continuous infusion...
Source: A&A Case Reports - March 15, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Difficulty Inserting Cuffed Endotracheal Tubes in a Child: A Case Report
We experienced difficulty inserting cuffed inner diameter (ID) 4.5- and 5.0-mm endotracheal tubes (ETTs) in a 5-year-old boy. Postoperative ultrasound investigations showed that the internal transverse width of the cricoid cartilage was 8.0 mm. The maximum outer diameter (OD) of the deflated cuff portion of the cuffed ID 4.5- and 5.0-mm ETTs was 8.5 and 9.6 mm, respectively. The OD of an uncuffed ID 5.5-mm ETT was 7.6 mm; this tube passed the cricoid cartilage. Hence, the transverse width of the cricoid cartilage and ETT diameter including cuff folds should be considered when selecting cuffed ETTs. (So...
Source: A&A Case Reports - March 15, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Cuffed Endotracheal Tubes in Children: Size Does Matter!
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - March 15, 2017 Category: Anesthesiology Tags: Editorials: Editorial Source Type: research

Asynchrony Between Ventilator Flow and Pressure Waveforms and the Capnograph on Dräger Anesthesia Workstations: A Case Report
Modern anesthesia workstations display capnography, flow-time, and pressure-time waveforms in real time. We observed that at certain ventilator settings (10 breaths/min) on Dräger workstations, the expiratory phase of the capnograph overlaps both the inspiratory and the expiratory phases of ventilation. This discrepancy disappears at respiratory rates of 16 breaths/min. This synchronous respiratory monitoring display at respiratory rates 16 breaths/min is not physiologically correct, because it implies a synchronization of waveforms that is not actually present. This again becomes asynchronous once the respiratory rat...
Source: A&A Case Reports - March 1, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Anesthetic Management of a Child With Jeune Syndrome for Tracheotomy: A Case Report
Jeune syndrome is a rare autosomal-recessive skeletal disorder. Anesthetic management of these patients is often difficult because of thoracic and lung hypoplasia. A 5-month-old boy with Jeune syndrome was scheduled to undergo a tracheotomy. Despite 5-minute preoxygenation with continuous positive airway pressure, the patient’s oxygen saturation rapidly dropped during the induction of anesthesia. The continuous positive airway pressure should have been titrated to effective tidal volume during preoxygenation to recruit the patient’s functional residual capacity and to prevent desaturation. During tracheotomy, v...
Source: A&A Case Reports - March 1, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Suspected Malignant Hyperthermia in the Setting of Hypothermic Circulatory Arrest for Type A Aortic Dissection Repair: A Case Report
We present a case of suspected MH in a patient undergoing emergent repair of a type A aortic dissection. Upon arrival at our institution, the patient had multiple signs of MH. However, no known triggering agent had been administered. Eventually, the unique physiologic changes of cardiopulmonary bypass provided strong support for the diagnosis of MH and dantrolene was administered, effectively treating the episode. (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Intravenous Tissue Plasminogen Activator Administration for Ischemic Stroke 1 Hour After Epidural Catheter Removal: A Case Report
This report describes a patient who developed ischemic stroke when receiving postoperative epidural analgesia. Tissue plasminogen activator was emergently administered 1 hour after epidural catheter removal with a favorable recovery. The patient and his family reviewed the manuscript, and written consent to publish this case report was obtained from the patient. (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Multidose Adenosine Used to Facilitate Microsurgical Clipping of a Cerebral Aneurysm Complicated by Intraoperative Rupture: A Case Report
We present a case in which the aneurysm ruptured and IV administration of adenosine was required to facilitate clipping. This case suggests that administering multiple consecutive precalculated doses of adenosine may be a safe method to manage aneurysmal rupture. (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Utilization of “Stand-By” Extracorporeal Membrane Oxygenation in a High-Risk Parturient With Methamphetamine-Associated Cardiomyopathy Undergoing Dilation and Evacuation: A Case Report
Parturients may present with evidence of acute heart failure or respiratory distress during the peripartum period. This case report documents utilization of “stand-by” extracorporeal membrane oxygenation (ECMO) for a 40-year-old woman with a history of severe left ventricular dysfunction who presented for elective dilation and evacuation of triplets at 20 weeks’ gestation. The patient’s medical history was significant for hypertension, diabetes mellitus, methamphetamine use (acute/chronic), and cardiac-respiratory arrest before her previous emergent cesarean delivery. The patient underwent general a...
Source: A&A Case Reports - March 1, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Management of a Patient With Antiphospholipid Syndrome Undergoing Aortic Valve Replacement Using the Hepcon Hemostasis Management System Plus and Rotational Thromboelastometry: A Case Report
A 72-year-old woman with antiphospholipid syndrome underwent aortic valve replacement. Her preoperative activated partial thromboplastin time was 61.7 seconds and activated clotting time was 219 seconds. During cardiopulmonary bypass, the Hepcon Hemostasis Management System (HMS) Plus determined the heparin dose needed to maintain whole-body heparin at 3 U/mL. After cardiopulmonary bypass, 100 mg of protamine was administered based on heparin-protamine neutralization, and the activated clotting time decreased. We applied rotational thromboelastometry (ROTEM) to diagnose residual heparin using the INTEM/HEPTEM clotti...
Source: A&A Case Reports - March 1, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Neurally Mediated Syncope During Cesarean Delivery: A Case Report
A 28-year-old woman with preeclampsia at 32 weeks of gestation underwent a cesarean delivery under spinal anesthesia. Administration of nitroglycerin at 200 μg to relax uterine smooth muscles and the application of fundal pressure led to severe bradycardia and loss of consciousness, followed by cardiac arrest. Delivery was completed immediately and recovery was achieved 10 seconds later following cardiopulmonary resuscitation. Neurally mediated syncope was considered the cause of cardiac arrest. Anesthetists should be aware of the potential risk during cesarean delivery following the administration of nitroglycerin, fun...
Source: A&A Case Reports - March 1, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Lateral Position for Cesarean Delivery Because of Severe Aortocaval Compression in a Patient With Marfan Syndrome: A Case Report
We report an obstetric patient case of severe aortocaval compression syndrome resulting in hypotension and loss of consciousness that ultimately underwent cesarean delivery under general anesthesia in the lateral position. Performing cesarean delivery in the lateral position is virtually unreported, and this unique strategy prevented further symptoms of aortocaval compression and enabled safe delivery. (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Crisis Management of Accidental Extubation in a Prone-Positioned Patient with Klippel-Feil Syndrome: Erratum
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - February 15, 2017 Category: Anesthesiology Tags: Erratum: Erratum Source Type: research

Profound Hypopnea With Xenon Anesthesia in a Free Diver
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - February 15, 2017 Category: Anesthesiology Tags: Case Reports: Letters to the Editor Source Type: research

Can Strategic Choices Keep Physician Anesthesiologists “In the Room Where It Happens?”
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - February 15, 2017 Category: Anesthesiology Tags: Case Reports: Letters to the Editor Source Type: research

A Case Report of Onyx Pulmonary Arterial Embolism Contributing to Hypoxemia During Awake Craniotomy for Arteriovenous Malformation Resection
A healthy 26-year-old man with cerebral arteriovenous malformation underwent staged endovascular embolization with Onyx followed by awake craniotomy for resection. The perioperative course was complicated by tachycardia and severe intraoperative hypoxemia requiring significant oxygen supplementation. Postoperative chest computed tomography (CT) revealed hyperattenuating Onyx embolization material within the pulmonary vasculature, and an electrocardiogram indicated possible right heart strain, supporting clinically significant embolism. With awake arteriovenous malformation resection following adjunctive Onyx embolization b...
Source: A&A Case Reports - February 15, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Rate-Dependent Left Bundle Branch Block in an Ambulatory Surgery Patient: A Case Report
A 52-year-old woman, ASA II (American Society of Anesthesia classification II) scheduled for cholecystectomy in an ambulatory center, exhibited a wide-complex tachycardia with ectopy on the monitor after induction with propofol and succinylcholine. Blood pressure remained stable; amiodarone was administered for presumed ventricular tachycardia. A 12-lead electrocardiogram (ECG) showed a new left bundle branch block (LBBB) at 98 beats per minute (bpm), which resolved when the heart rate slowed. Surgery was postponed, and both the LBBB and ectopy recurred frequently during the next 24 hours in the intensive care unit, partic...
Source: A&A Case Reports - February 15, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Perioperative Management of a Patient With an Intrathecal Drug Delivery Device Infusing Ziconotide: A Case Report
Intrathecal ziconotide is used for the treatment of chronic pain and is delivered by an implanted drug delivery device. Anesthesiologists should be familiar with the perioperative management of the pump as well as the potential adverse events related to continued ziconotide infusion during general anesthesia. A case is presented demonstrating the perioperative management of an intrathecal drug delivery device infusing ziconotide in a patient presenting for radical cystectomy with pelvic lymphadenectomy and ileal conduit diversion. (Source: A&A Case Reports)
Source: A&A Case Reports - February 15, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Case Report: Red Urine After Day Care Strabismus Surgery
In the absence of surgery on the urinary tract, the emission of red urine after anesthesia should be considered as a diagnostic emergency because it can be a sign of hematuria, hemoglobinuria, blood transfusion reaction, significant myoglobinuria, or porphyria. This case describes the management of a 12-year-old boy who presented red urine at the day care unit after strabismus surgery. (Source: A&A Case Reports)
Source: A&A Case Reports - February 15, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Out-of-Hospital Perimortem Cesarean Delivery Performed in a Woman at 32 Weeks of Gestation: A Case Report
A 34-year-old pregnant woman experienced cardiac arrest at home. Out-of-hospital perimortem cesarean delivery was performed 27 minutes after the collapse. Both mother and child were resuscitated and had return of spontaneous circulation before they were transported to a university hospital. The mother underwent hysterectomy and developed disseminated intravascular coagulation. Despite intensive treatment, she died 8.5 hours after arrival. The infant was extubated the next day, and her subsequent hospital course was uneventful. She was later diagnosed with cerebral palsy and severe gastroesophageal reflux. At 2 years of age...
Source: A&A Case Reports - February 15, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Challenging Airway Secondary to Purpura Fulminans With Face and Neck Bullae in a Premature Infant: A Case Report
We describe how we subsequently secured the airway and make recommendations on how to avoid this problem in the future and for rescue preparation before the procedure. (Source: A&A Case Reports)
Source: A&A Case Reports - February 15, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Metallosis Identified via Intraoperative Cell Salvage: A Case Report
Intraoperative cell salvage, whereby shed surgical blood is recovered for autologous reinfusion, is frequently used during hip arthroplasty because of the potential for significant blood loss. The following cases describe 2 instances in which chromium and cobalt particles from patients’ metal-on-metal hip implants were identified within the blood recovery system. Results of heavy metal testing during the second case suggest that the use of a leukocyte reduction filter effectively reduces metal concentrations to below normal circulating levels. However, the reinfusion of cell salvage blood containing obvious metallic ...
Source: A&A Case Reports - February 15, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Lipid Emulsion Rescue of Amniotic Fluid Embolism-Induced Cardiac Arrest: A Case Report
We present a patient with an AFE who developed disseminated intravascular coagulation and cardiovascular collapse who may have benefitted from intravascular lipid emulsion rescue. This is the first published case in which lipid emulsion was a part of the successful treatment of AFE. (Source: A&A Case Reports)
Source: A&A Case Reports - February 1, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Anesthetic Considerations for Pneumonectomy With Left Atrial Resection on Cardiopulmonary Bypass in a Patient With Lung Cancer: A Case Report
Cases of pneumonectomy plus atrial resection for lung cancer have been reported in the surgical literature, but not the anesthesia literature. To achieve curative resection, cardiopulmonary bypass (CPB) may be necessary. Although CPB may complicate the management of these high-risk patients, these cases should always be undertaken in a center where it is immediately available. Here, we discuss the anesthetic management of a 70-year-old man with left lower lobe lung cancer invading the left inferior pulmonary vein and left atrium. (Source: A&A Case Reports)
Source: A&A Case Reports - February 1, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Pheochromocytoma Multisystem Crisis Triggered by Glucocorticoid Administration and Aggravated by Citrate Dialysis
We report on a 68-year-old survivor of pheochromocytoma multisystem crisis, whose clinical course was triggered inadvertently by a short innocuous course of oral dexamethasone to suppress inflammation and swelling after a left orbital floor fracture repair. He presented first with severe epigastric pain and headache, and subsequently experienced insults to neurological, cardiac, respiratory, hepatobiliary, renal, and immune system in his prolonged intensive care unit stay. We believe an episode of unexpected hypertensive crisis in the intensive care unit was set off iatrogenically during citrate protocol dialysis. (Source:...
Source: A&A Case Reports - February 1, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Intraoperative Presentation of Malignant Hyperthermia (Confirmed by RYR1 Gene Mutation, c.7522C>T; p.R2508C) Leads to Diagnosis of King-Denborough Syndrome in a Child With Hypotonia and Dysmorphic Features: A Case Report
We present the novel case report of a child with hypotonia and dysmorphic features who developed malignant hyperthermia (MH) intraoperatively. Neurology workup revealed the presence of a known causative ryanodine receptor (RYR1) mutation for MH, c.7522C>T; p.R2508C. Furthermore, the neurology workup diagnosed the child with King-Denborough syndrome (KDS). This particular mutation has never been documented in a patient with KDS. Atypical presentation of MH is more likely in patients with RYR1-related myopathy. A high index of suspicion for MH in children with myopathy is important. The MH hotline was helpful in the manag...
Source: A&A Case Reports - February 1, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Severe Intraoperative Shock Related to Mesenteric Traction Syndrome
We describe a case of mesenteric traction syndrome refractory to catecholamine and vasopressin infusions. The patient, who had Crohn disease, developed severe distributive shock after mesenteric traction while undergoing resection of an intestinal inflammatory mass, accompanied by facial flushing and unaltered readings for pulse oximetry, capnography, and bispectral index monitoring. The absence of tachycardia in this case was attributed to long-term use of timolol. Arterial pressure returned to baseline level after approximately 30 minutes, and the postoperative period was uneventful. (Source: A&A Case Reports)
Source: A&A Case Reports - February 1, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Two Cardiac Arrests Because of Venous Air Embolism During Endoscopic Retrograde Cholangiopancreatography: A Case Report
We report 2 cases of venous air embolism and subsequent cardiac arrests. During resuscitation efforts, a transesophageal echocardiogram was placed, which demonstrated significant air in the right heart. Although gastroenterologists seem to be more aware of this complication, it is underreported in the anesthesiology literature. As anesthesiologists continue to expand coverage to endoscopy suites, anesthesia providers must be aware of predisposing factors and maintain a high index of suspicion to recognize and treat in a timely manner to prevent serious adverse outcomes. (Source: A&A Case Reports)
Source: A&A Case Reports - February 1, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Low Cardiac Output After Orthotopic Heart Transplant Secondary to Large Inferior Vena Cava Thrombus After Prothrombin Complex: A Case Report
Low cardiac output after orthotopic heart transplant (OHT) may be attributed to inadequate preload, vasodilation, and/or reduced inotropy. Inadequate preload because of an inferior vena cava (IVC) thrombus is a rare cause of low cardiac output and not frequently described in the literature. Although the use of prothrombin complex (PCC) has been associated with thrombus formation, its contribution to life-threatening IVC thrombosis has yet to be described. This case report describes the use of perioperative ultrasound in the diagnosis and management of a low cardiac output state induced by an IVC thrombus in an OHT recipien...
Source: A&A Case Reports - February 1, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Iatrogenic Right Coronary Artery Occlusion Following Tricuspid Valve Repair: Case Report of a Rare but Recognized Complication
Iatrogenic occlusion of the right coronary artery (RCA) is a rare complication after tricuspid valve surgery. We review the case of a 74-year-old female who presented for mitral and tricuspid valve annuloplasty. Unanticipated postcardiopulmonary bypass biventricular hypokinesis was encountered, necessitating extracorporeal support. Emergent coronary angiography demonstrated near-complete RCA occlusion from a taut periarterial suture near the RCA. Deployment of a drug-eluting stent restored normal flow, and the patient made a full recovery. Although an exceedingly rare complication, iatrogenic RCA injury after tricuspid val...
Source: A&A Case Reports - January 15, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Use of Prothrombin Complex Concentrate for Warfarin Reversal Before the Performance of an Epidural Blood Patch in a Patient With Cortical Vein Thrombosis and Subdural Hematoma: A Case Report
We present a novel use of PCC in a patient with intracranial hypotension, who had received warfarin for treatment of cortical vein thrombosis. However, after anticoagulation, she proceeded to develop bilateral subdural hematomas with descent of cerebellar tonsils. Given the possibility of an occult dural puncture during labor analgesia, an epidural blood patch was performed after administration of PCC and normalization of coagulation parameters, with prompt improvement of the patient’s headache. (Source: A&A Case Reports)
Source: A&A Case Reports - January 15, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Use of Methohexital and Dexmedetomidine for Maintenance of Anesthesia in a Patient With Mitochondrial Myopathy: A Case Report
Provision of anesthesia for patients with mitochondrial disorders is associated with a unique set of challenges. These disorders are rare, which complicates efforts to develop high quality, evidence-based guidelines to inform the perioperative management of those who suffer from them. Accordingly, case reports remain an important source of information regarding their care. Here we present the case of a 27-year-old female patient with mitochondrial myopathy and a history suggestive of malignant hyperthermia susceptibility who received general anesthesia for 2 consecutive surgeries. The induction agents included fentanyl, ke...
Source: A&A Case Reports - January 15, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Transversus Abdominis Plane Block for Inguinal Hernia Repair in a Premature Infant: A Case Report
This report also briefly explains the advantages of using a transversus abdominis plane block, compared with neuraxial blockade, for hernia repair surgery. (Source: A&A Case Reports)
Source: A&A Case Reports - January 15, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Peripheral Neuromodulation for the Treatment of Postamputation Neuroma Pain: A Case Report
We present a case of a 37-year-old female amputee who suffered from severe neuroma pain, which had proved resistant to pharmacologic treatment, glycerol injections, spinal cord stimulation, radiofrequency thermocoagulation, and repeated surgical removals. After treatment with peripheral nerve stimulation, using a St. Jude Medical Octrode lead implanted percutaneously under ultrasound guidance close to her painful neuroma, her ongoing pain dramatically decreased from 8 to 3 on a numeric rating scale (0–10). Peripheral neuromodulation is a promising relatively new treatment that can be used for neuroma pain. (Source: A&A Case Reports)
Source: A&A Case Reports - January 15, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Massive Subcutaneous Emphysema and Bilateral Tension Pneumothoraces After Supplemental Oxygen Delivery via an Airway Exchange Catheter: A Case Report
A patient suffered massive subcutaneous emphysema and bilateral tension pneumothoraces after receiving supplemental oxygen through an airway exchange catheter (AEC). Complications of AEC placement include misplacement, direct injury to the larynx, bronchi or lung, barotrauma related to oxygen supplementation, and a loss of airway. We review these complications and discuss the specific risks of supplementing oxygen using an AEC. We suggest measures to limit pressure from the oxygen source and warn against advancing an AEC too far into the tracheobronchial tree. (Source: A&A Case Reports)
Source: A&A Case Reports - January 15, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research