Tracheal Extubation of Patients With Cervical Spine Injury: A Case Report and Review of Literature
We report a case of a patient with a potentially unstable cervical spine injury who presented for a nonspinal surgery and experienced agitation on emergence from anesthesia. The use of an intravenous sedative was necessary to ensure cervical spine immobilization but was complicated by severe respiratory depression and the need for reintubation and admission to intensive care. The case report is followed by a review of literature relating to safe extubation of patients with cervical spine injuries. Possible complications during emergence and various methods to prevent these complications are discussed. (Source: A&A Case Reports)
Source: A&A Case Reports - January 15, 2017 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Successful Treatment of Persistent Pain After Pectus Excavatum Repair Using Paravertebral Nerve Radiofrequency Thermoablation
We present a case of a 25-year-old male patient suffering from severe prolonged pain after uneventful pectus excavatum repair that could be treated successfully by paravertebral nerve radiofrequency thermoablation. The patient was scheduled for a minimally invasive Nuss pectus excavatum repair. Surgical correction was performed under general anesthesia in combination with a thoracic peridural catheter. The immediate postoperative course was uneventful; however, the patient developed severe prolonged bilateral chest wall pain across segments T8 and T9. After failure of conservative treatment options, a specialized intervent...
Source: A&A Case Reports - December 31, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Failed Vocalis Muscle Monitoring During Thyroid Surgery Resulting From Residual Muscle Relaxation
Postoperative paralysis of the vocal cords resulting from intraoperative surgical injury of the recurrent laryngeal nerve is one of the most serious complications of elective thyroid surgery. The chance of injury is reduced by using intraoperative neuromonitoring (IONM). This educational report describes a case of IONM failure resulting from residual muscle relaxation that was restored by administration of sugammadex. It discusses possible pharmacology explanations and provides recommendations for how to prevent this situation in daily practice. (Source: A&A Case Reports)
Source: A&A Case Reports - December 31, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Case Report of Severe Antithrombin Deficiency During Extracorporeal Membrane Oxygenation and Therapeutic Plasma Exchange for Double Lung Transplantation
We report a case of acquired AT deficiency and resultant multiple deep vein thrombosis in a patient with pulmonary fibrosis on veno-venous extracorporeal membrane oxygenation who underwent double lung transplantation with intraoperative therapeutic plasma exchange (TPE) as a part of an immunomodulation regimen for allosensitization. Preoperative heparin anticoagulation resulted in AT deficiency, which was further exacerbated by TPE using albumin. The recovery of AT activity after TPE with plasma was incomplete, and postoperative deficiencies of AT and other anticoagulants might have contributed to deep vein thromboses. The...
Source: A&A Case Reports - December 31, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Optimization of Mechanical Ventilation in a 31-Year-Old Morbidly Obese Man With Refractory Hypoxemia
We present the case of a 31-year-old patient with severe refractory hypoxemia reversed by lung recruitment maneuvers and subsequent application of positive end-expiratory pressure (PEEP) at a level determined by a decremental PEEP trial. The patient was extubated at a high PEEP level of 22 cm H2O followed by noninvasive ventilatory support after extubation. This case suggests that a recruitment maneuver followed by PEEP titration is necessary in obese patients for optimizing mechanical ventilation. Extubation to noninvasive ventilatory support with the identified optimal PEEP may decrease an inappropriate increased ...
Source: A&A Case Reports - December 31, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Quadratus Lumborum Block as an Alternative to Lumbar Plexus Block for Hip Surgery: A Report of 2 Cases
We report 2 cases of prolonged, extensive block of thoracic and lumbar dermatomes after QL block in patients undergoing different hip surgery procedures for whom QL block was used in place of lumbar plexus block. Further prospective studies comparing these 2 techniques are necessary to better characterize the role of QL block in hip surgery. (Source: A&A Case Reports)
Source: A&A Case Reports - December 31, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Unanticipated Compression of the Trachea in a 5-Month-Old Undergoing an MRI for Evaluation of Neurofibromatosis
We describe the case of a 5 month old with a plexiform neurofibroma of the neck who developed complete airway obstruction on induction of anesthesia. Magnetic resonance imaging revealed a skull base neurofibroma extending to the hypopharynx and resulting in deviation of the airway. Because of the possibility of airway involvement, a careful preanesthetic evaluation as well as a slow induction with the maintenance of spontaneous ventilation should be considered in patients presenting with facial neurofibromas. (Source: A&A Case Reports)
Source: A&A Case Reports - December 31, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Hypertensive Crisis From the Aquamantys Bipolar Sealing System
Hypertension is a common occurrence during general anesthesia. Apart from pathological causes of hypertension, it is rarely extreme enough to be classified as a hypertensive crisis (systolic blood pressure>180 mm Hg or diastolic blood pressure>120 mm Hg). There is literature concerning the unintentional electrocauterization of the adrenal gland leading to hypertensive crisis, but to date, no reports have been made of adrenal stimulation from the use of an Aquamantys for hemostasis. Here, we report such a case when a hypertensive crisis (systolic blood pressure>300 mm Hg) occurred while using a...
Source: A&A Case Reports - December 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Garlic-Induced Surgical Bleeding: How Much Is Too Much?
A patient underwent C2–T2 decompression and fusion with excessive intraoperative bleeding and no clear source. The patient denied the use of blood-thinning medications, but had consumed the equivalent of 12 g garlic daily in the days leading up to the surgery. He was treated with desmopressin acetate (DDAVP) and cryoprecipitate with adequate control of bleeding. Garlic is known to have an antiplatelet effect, although the dose range necessary to create a bleeding abnormality has not yet been well described nor has the effect of taking garlic with sertraline or other agents with an established or potential effe...
Source: A&A Case Reports - December 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Fully Automated Anesthesia and Fluid Management Using Multiple Physiologic Closed-Loop Systems in a Patient Undergoing High-Risk Surgery
Automated delivery of anesthesia guided by processed electroencephalogram monitoring using a closed-loop system is no longer a novel concept. However, combining multiple independent physiologic closed-loop systems together has never been documented before. The purpose of this case report was to evaluate the feasibility of automated anesthesia and fluid management based on a combination of physiological variables (bispectral index, stroke volume, and stroke volume variations) using 2 independent closed-loop systems. (Source: A&A Case Reports)
Source: A&A Case Reports - December 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Airway Management of a 3-Year-Old Child With a Penetrating Oropharyngeal Foreign Body Risking Vascular Injury
We present the case of a 3-year-old girl who presented to the emergency department with a 12-cm sewing needle protruding from her mouth and unknown vascular involvement. We were faced with establishing a secure airway despite exclusion of mask ventilation or use of a laryngeal mask airway. Moreover, peripheral intravenous access was lost before adequate sedation. Ultimately, we were able to safely induce anesthesia and achieve endotracheal intubation. The penetrating foreign body was removed with no perioperative complications. (Source: A&A Case Reports)
Source: A&A Case Reports - December 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Left Ventricular Assist Device Insertion in a Patient With Biventricular Noncompaction Cardiomyopathy, Ebstein Anomaly, and a Left Atrial Mass: A Case Report
In this report, we present the case of a patient with biventricular noncompaction cardiomyopathy, Ebstein anomaly, and a left atrial mass who required emergent placement of a left ventricular assist device. The noncompaction cardiomyopathy complicated the left ventricular assist device implantation procedure because the thickened, trabeculated myocardium made it difficult to place the inflow cannula. We discuss our perioperative management strategy, in which transesophageal echocardiography was used, to help the surgical team identify the proper cannula placement and provide a bridge to transplantation. (Source: A&A Case Reports)
Source: A&A Case Reports - December 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Hydroxocobalamin for Vasoplegic Syndrome in Liver Transplantation: Restoration of Blood Pressure Without Vasospasm
In this report, we present a case in which treatment with conventional vasopressors caused peripheral arterial spasm, rendering arterial blood pressure monitoring impossible. Administration of methylene blue resolved the vasospasm; however, concern for toxic dose requirements limited its use. Hydroxocobalamin administration resolved the vasospasm and increased blood pressure without the potential adverse effects seen with methylene blue. This case represents the first report of hydroxocobalamin use in liver transplantation and may represent a new option for the treatment of vasoplegia and the potential vasospasm that may r...
Source: A&A Case Reports - December 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

A Case of Delayed Emergence After Propofol Anesthesia: Genetic Analysis
This case report describes a 71-year-old woman who experienced unusual delayed emergence from propofol, which lasted for 3 hours and resulted in admission to the intensive care unit. Because genetic variations of propofol-metabolizing enzymes are proposed to be causal factors, we explored genetic polymorphisms of cytochrome P450 2B6 (CYP2B6) and uridine 5′-diphospho-glucuronosyltransferase 1A9 (UGT1A9). Suggested high-risk factors (advanced age, CYP2B6 516 G/T, and UGT1A9 I399 C/C) were observed in this case of delayed propofol metabolism. Therefore, genetic variants involved in propofol metabolism should be consider...
Source: A&A Case Reports - December 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Massive Fulminant Thrombosis During Liver Transplantation in a Patient With a Previously Unknown Antithrombin Pathway Mutation
We describe a case of fulminant intraoperative thrombosis during deceased donor liver transplantation. Despite significant medical bleeding, the patient suddenly developed diffuse thrombosis in all chambers of the heart and pulmonary vasculature resulting in intraoperative death. The patient’s postmortem genetic analysis demonstrated a deleterious missense mutation in a coagulation pathway gene, SERPINC1, which codes for antithrombin III. The level of antithrombin III was not available to directly prove the causality of thrombosis, but our findings suggest that this mutation, in combination with antifibrinolytic admi...
Source: A&A Case Reports - December 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Anesthetic Management for Pediatric Awake Tracheostomy
We describe the anesthetic management of an awake tracheostomy performed on a 7-year-old girl, with a large supraglottic mass obstructing the laryngeal introitus. (Source: A&A Case Reports)
Source: A&A Case Reports - December 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Polymyxin B Direct Hemoperfusion Using Regional Citrate–Calcium Anticoagulation: A Case Report
We present a case report of a postsurgical septic patient treated with 2 cycles of PMX-DHP using citrate anticoagulation. Monitoring of serum calcium, postcartridge calcium, and acid–base balance was performed. The treatments were accomplished without complications. To our knowledge, this is the first published report on the use of citrate anticoagulation during PMX-DHP. We conclude that citrate anticoagulation is feasible during hemoperfusion therapy in patients with increased hemorrhagic risk. (Source: A&A Case Reports)
Source: A&A Case Reports - December 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Reversal of Anticoagulation With Dabigatran in an 82-Year-Old Patient With Traumatic Retroperitoneal Arterial Bleeding Using the New Antidote Idarucizumab: A Case Report
We report the case of an 82-year-old patient with traumatic retroperitoneal arterial bleeding under anticoagulation with dabigatran etexilate. By administration of idarucizumab, we successfully normalized coagulation and saved the patient from an operation. In the course of the disease, a slight reincrease in dabigatran etexilate plasma levels was observed 2 days after the reversal, which could lead to a new onset of bleeding. (Source: A&A Case Reports)
Source: A&A Case Reports - December 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Unsuccessful Redo MitraClip Procedure Leads to Acute Right Ventricular Failure in a Patient With Homozygous Familial Hypercholesterolemia and a Preexisting Atrial Septal Defect
We present the case of a failed redo MitraClip procedure that led to acute right ventricular failure in a patient with homozygous familial hypercholesterolemia and a preexisting secundum atrial septal defect. We highlight the sequelae of the failed redo MitraClip procedure and the anesthetic challenges associated with the emergent redo sternotomy and cardiopulmonary bypass procedure required to replace the mitral valve and repair the tricuspid valve and atrial septal defect. (Source: A&A Case Reports)
Source: A&A Case Reports - December 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Epidural Management by Nonanesthesiologists: Is This an Example of Poor Care Coordination?
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - November 15, 2016 Category: Anesthesiology Tags: Case Reports: Letter to the Editor Source Type: research

A Case Report of the Anesthetic Management for Liver Retransplantation in a Patient With a Bronchobiliary Fistula
We present anesthestic considerations for the intraoperative management of a liver retransplant with one-lung ventilation. (Source: A&A Case Reports)
Source: A&A Case Reports - November 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Use of Perfluorodecalin for Bronchoalveolar Lavage in Case of Severe Pulmonary Hemorrhage and Extracorporeal Membrane Oxygenation: A Case Report and Review of the Literature
We present a patient on venovenous extracorporeal membrane oxygenation for respiratory failure, secondary to complete airway obstruction from pulmonary hemorrhage after open pulmonary embolectomy. Obstruction was refractory to conventional therapy, including mechanical debridement and saline lavage. By using perfluorodecalin, we were able to transiently clear the airways of thrombus and reopen distal airways and alveoli more completely than with conventional therapies. The use of perfluorodecalin (versus radiopaque perflubron) enabled us to visualize this reopening on chest X-ray. (Source: A&A Case Reports)
Source: A&A Case Reports - November 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Impaired Ventilation and Oxygenation After Emergency Cricothyrotomy: Recommendations for the Management of Suboptimal Invasive Airway Access
We report a case of severely compromised respiratory function while using the Quicktrach II, a commercially available emergency cricothyrotomy device. Because of oxygenation and ventilatory insufficiency, our patient required emergent removal of the device and surgical tracheostomy to improve respiratory function. When confronted with a difficult airway, anesthesiologists and surgeons should be aware of commonly encountered cricothyrotomy devices and their potential limitations. (Source: A&A Case Reports)
Source: A&A Case Reports - November 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Spontaneous Intracranial Hypotension: An Etiology for Consciousness Disorder and Coma
We report 3 cases of spontaneous intracranial hypotension (SIH) associated with consciousness disorder and coma. In patients, SIH was suspected on a computed tomography scan and diagnosed by cerebral magnetic resonance imaging (MRI). Spinal MRI confirmed cerebrospinal fluid leakage. SIH should be seen as an underestimated cause of consciousness disorder and coma, especially in patients with a history of orthostatic headache, spinal injury, or oculomotor signs. Computed tomography scans should be examined for signs of SIH before operating on patients with a spontaneous subdural hematoma. Brain and spine MRI should be perfor...
Source: A&A Case Reports - November 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Ultrasound-Guided Temporomandibular Joint Injection for Chronic Posthemimandibulectomy Jaw Pain
We describe a patient with left jaw pain after right hemimandibulectomy. The patient was initially managed conservatively, which failed to reduce pain. He was then administered inferior alveolar nerve block and TMJ injection with steroid and local anesthetic. These injections provided temporary pain relief that lasted approximately 1 month and the pain recurred. Computed tomography scan showed lateral displacement of left mandibular condyle. He was then given ultrasound-guided TMJ injection of steroid and local anesthetic. This injection provided lasting pain relief. (Source: A&A Case Reports)
Source: A&A Case Reports - November 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Iatrogenic Pseudoaneurysm After Continuous Adductor Canal Block
We present a case of iatrogenic pseudoaneurysm in a branch of the superficial femoral artery in a 44-year-old patient after a cACB for knee surgery. Both anesthesia and surgery were completed uneventfully. The postoperative day 3 examination showed a complete quadricep impairment and a large hematoma in a medial-anterior part of the thigh, and laboratory tests reported hemoglobin = 7.2 g dL−1. The computed tomography scan revealed the pseudoaneurysm (16 × 16 × 18 mm) that was successfully embolized after selective catheterization. The patient was discharged regula...
Source: A&A Case Reports - November 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Extracorporeal Membrane Oxygenation for Treatment of Acute Inverted Takotsubo-Like Cardiomyopathy From Hemorrhagic Pheochromocytoma in Late Pregnancy
We describe the first case of a pregnant woman presenting with an acute inverted takotsubo-like cardiomyopathy caused by a postpartum diagnosed hemorrhagic pheochromocytoma, successfully treated with percutaneous venoarterial extracorporeal membrane oxygenation (va-ECMO). During admission, an emergency cesarean delivery had to be performed. The fetus needed resuscitation for 5 minutes. The mother was successfully resuscitated and treated with percutaneous va-ECMO for 7 days. Despite advances in diagnostic techniques during the past decade, in many cases, pheochromocytoma in pregnancy is still missed. This results in a mate...
Source: A&A Case Reports - November 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Preoperative Assessment of the Impact of Positive Pressure Ventilation With Noninvasive Positive Pressure Ventilation in a Patient With Eisenmenger Syndrome: A Case Study
In Eisenmenger syndrome (ES), positive pressure ventilation (PPV) during general anesthesia may lead to an increase in pulmonary vascular resistance and potentially to hypoxemia. In an attempt to predict the patient’s hemodynamic response to intraoperative ventilation, we tested preoperatively the hemodynamic effects of noninvasive PPV with continuous positive pressure in a woman with ES scheduled for oophorectomy. The surgery was performed without complications, and the patient was discharged on postoperative day 8. (Source: A&A Case Reports)
Source: A&A Case Reports - November 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

The First Case Report of Anaphylaxis Caused by the Inclusion Complex of Rocuronium and Sugammadex
A 50-year-old man developed a severe anaphylactic reaction shortly after the administration of sugammadex at the end of an uneventful laparoscopic appendectomy. Subsequent skin testing was negative to all agents to which the patient was exposed including sugammadex. Because of the temporal relationship to the administration of sugammadex, further skin testing was performed with premixed sugammadex and rocuronium that produced a markedly positive response. This is the first case report of anergy to the individual components but sensitivity to the inclusion complex of rocuronium and sugammadex. Written informed consent was o...
Source: A&A Case Reports - November 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

A Rare Case of Hydromorphone-Induced Angioedema Effectively Managed by a Difficult Airway Response Team
We report a rare case of hydromorphone-induced angioedema in a 34-year-old woman with history of deep venous thrombosis and pulmonary embolism who presented with leg swelling and pain after trauma. Hydromorphone was administered with subsequent rapid development of stridor and edematous changes of the tongue, uvula, and surrounding mucosa. The difficult airway response team was activated, and the airway was secured by emergent awake fiberoptic intubation in the operating room. After being treated with antihistamines and steroids for 24 hours, the airway edema had resolved, leading to a successful extubation. (Source: A&A Case Reports)
Source: A&A Case Reports - November 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Upper Extremity Peripheral Intravenous Line Infiltration With Concomitant Loss of Pulses Treated With Lipoaspiration: A Case Report
We present a case where a large volume of blood, administered through a small peripheral cannula in the antecubital fossa, was found to have extravasated into the soft tissues, causing catastrophic vascular compromise. The expedient removal of the extravasate using a lipoaspiration cannula restored perfusion immediately to the affected limb and negated the need for surgical fasciotomies. (Source: A&A Case Reports)
Source: A&A Case Reports - November 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Anesthetic Management of Conjoined Twins for Computed Tomography Scan
We report a case of 3-month and 10-day-old xiphopagus twins undergoing computed tomography scan under general anesthesia. The issues in their management in radiology included the unknown effects of anesthetic agents on circulation because of sharing of organs, duplication of staff, equipment in a limited space, placing the children on the scan table, airway control and ventilator management, and changeover of equipment during procedure. (Source: A&A Case Reports)
Source: A&A Case Reports - October 14, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Management of 1-Lung Ventilation in a Patient With Failing Fontan Circulation
Discussion focuses on the management of volume status and pulmonary vascular resistance as well as surgical implications of Fontan physiology in thoracic surgery. (Source: A&A Case Reports)
Source: A&A Case Reports - October 14, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Lessons Still Being Learned: Acute Pulmonary Tumor Embolus During Renal Cell Carcinoma Resection
We present a case of unexpected pulmonary embolism diagnosed during RCC surgery. The case highlights the central importance of intraoperative transesophageal echocardiography use and the need for proper preoperative planning for the use of cardiopulmonary bypass. (Source: A&A Case Reports)
Source: A&A Case Reports - October 14, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Esophageal Submucosal Hematoma Possibly Caused by Gastric Tube Insertion Under General Anesthesia
We present a case of an esophageal submucosal hematoma that developed after endovascular treatment for coil embolization for an unruptured cerebral aneurysm. The patient had received antiplatelet therapy before surgery and anticoagulation therapy during surgery. The orogastric tube was removed at case end with sustained negative pressure. After surgery, the patient reported chest and back pain and was diagnosed with an esophageal submucosal hematoma. The hematoma might have been related to the gastric tube insertion or removal. Providers should keep in mind the possibility of this complication when a patient who was given ...
Source: A&A Case Reports - October 14, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Anesthetic Considerations for Neuraxial Anesthesia in Pregnant Patients With Pityriasis Rosea With Skin Lesions Covering the Lumbar Spine
This article uses the first-known epidural placement through active PR to illustrate risk–benefit considerations when deciding between neuraxial and general anesthesia for obstetric patients with PR. (Source: A&A Case Reports)
Source: A&A Case Reports - October 14, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Successful Treatment of Refractory Hypoxemia Secondary to Disseminated Histoplasmosis Using Extracorporeal Membrane Oxygenation Support
We present a case of successful ECMO use in a host with refractory hypoxemia secondary to disseminated histoplasmosis with fungemia and discuss our management approach to this difficult patient. (Source: A&A Case Reports)
Source: A&A Case Reports - October 14, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Successful Anticoagulation Using Argatroban During Transcatheter Aortic Valve Implantation in a Patient With Heparin-Induced Thrombocytopenia
We report the first case of transfemoral transcatheter aortic valve implantation with a history of heparin-induced thrombocytopenia that was successfully managed with perioperative argatroban. (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Do Not Burn Your Airway Bridge: A Technique to Safely Exchange a Tracheostomy Tube for a Tracheal Tube
We present a case in which an airway exchange catheter was used to safely replace a tracheostomy tube with a tracheal tube in a patient with a fresh tracheostomy. (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Periarticular Morphine-Induced Sphincter of Oddi Spasm Causing Severe Pain and Bradycardia in an Awake Patient Under Spinal Anesthesia: An Important Diagnostic Consideration
We present a case of sphincter of Oddi spasm from periarticular morphine in a patient under spinal anesthesia, causing severe distress and treated effectively with glucagon. It is important for anesthesiologists using opioids to consider it as a cause of perioperative pain and be familiar with treatment as it may be refractory by conventional use of opioids for pain relief. It is also important to consider the systemic effects of periarticular absorption, as evident by our case. (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Difficult 32-Fr Double-Lumen Tube Intubation in a Small Japanese Woman With Narrow Transverse Width of the Cricoid Cartilage
We encountered difficulty in inserting a 32-Fr left double-lumen tube (DLT) in a small 75-year-old Japanese woman (height, 144 cm). The 32-Fr DLT with 10.1 × 11.2-mm tracheal diameter could not pass through the cricoid cartilage with a 9.2-mm transverse inner width. The transverse inner width of the cricoid cartilage, in addition to the tracheal and bronchial diameter, can be measured using computed tomography or ultrasonography in small women. Thus, a 28-Fr DLT or single-lumen tube and a blocker can be selected instead of a 32-Fr DLT when the width of the cricoid cartilage is (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Anesthetic Management for Cesarean Delivery in a Patient With Pulmonary Emboli, Pulmonary Hypertension, and Right Ventricular Failure
We describe a cesarean delivery performed using an intrathecal catheter in a 25-year-old morbidly obese (body mass index, 82 kg/m2) woman (gravida 3, para 2 at 32 weeks of gestation) who had severe pulmonary hypertension, right ventricular failure, pulmonary emboli, and obstructive sleep apnea. We discuss the anesthetic considerations for parturients with severe pulmonary hypertension undergoing cesarean delivery including the selection of anesthetic technique, vasopressors, and uterotonic agents. (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Airway Management and Definitive Care of a Toddler Following Impalement Injury by a Metal Straw
Although pediatric trauma benefits from specialized pediatric care, at times, nonpediatric centers are required to provide initial management. In this unusual airway impalement injury, the combination of smooth coordination between emergency medicine and anesthesia, an articulated airway strategy, parental involvement, and clear, calm teamwork maximized patient safety during airway securement and transfer for definitive care. The airway strategy included the anticipation that the first attempt at endotracheal intubation may not be successful and the need to keep the “auditory space” clear. Public health warning...
Source: A&A Case Reports - October 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

A Novel Approach to Brachial Plexus Catheter Management: A Brachial Plexus Test Dose for Phrenic Nerve Paralysis and Patient-Controlled, Demand-Only Dosing for a Patient With Extreme Obesity
This report describes the novel management of her continuous brachial plexus catheter in the setting of her comorbidities. Phrenic nerve paralysis from brachial plexus blocks can cause clinically significant dyspnea in obese patients. Brachial plexus catheters can be used effectively for these patients with some modification to routine management. We detail our use of a short-acting chloroprocaine test dose for phrenic paralysis and demand-only dosing to provide effective analgesia while avoiding respiratory complications associated with these blocks. (Source: A&A Case Reports)
Source: A&A Case Reports - September 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

A Novel and Multidisciplinary Strategy for Cesarean Delivery With Placenta Percreta: Intraoperative Embolization in a Hybrid Suite
Cesarean deliveries in patients with placenta accreta often are accompanied by life-threatening bleeding and sometimes death. A novel, multidisciplinary approach that uses uterine embolization after cesarean delivery recently has been advocated; however, embolization in the radiology department requires transfer of postoperative patients, which could increase maternal mortality and morbidity. In a case of severe placenta accreta, we planned a stepwise treatment, including cesarean delivery without separation of the placenta followed by intraoperative uterine arterial embolization in a hybrid operating room, followed by hys...
Source: A&A Case Reports - September 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

One-Lung Ventilation for Lung Lobectomy Using Endobronchial Blocker Through Adjustable Silicon Hyperflex Tracheostomy Tube in Postlaryngectomy Patient
One-lung ventilation is challenging in patients with difficult airway who require lung surgery. The choice of airway technique remains limited in patients with permanent tracheostomy after total laryngectomy. Conventional airway management techniques and available airway equipment have limited the options for securing airway in such patients, and dedicated airway equipment is not available for the management of such patients. Here, using endobronchial blocker through adult silicon hyperflex tracheostomy tube with an adjustable flange, we report a successful airway management for 1-lung ventilation in a patient with total l...
Source: A&A Case Reports - September 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Continuous Quadratus Lumborum Block for Postoperative Pain in Total Hip Arthroplasty: A Case Report
A 69-year-old man with a history of chronic pain and opioid use presented for total hip arthroplasty. In the interests of ensuring early mobilization and pain control, we chose a continuous quadratus lumborum block technique, a novel ultrasound-guided block that has not yet been described for total hip arthroplasty, hypothesizing that it would be motor-sparing. While the perineural catheter was infused, the patient required no IV opioids. He was able to ambulate on the first postoperative day, reporting pain scores between 0 and 3/10. The quadratus lumborum block is a promising technique that, in our patient, was motor-spa...
Source: A&A Case Reports - September 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Bilateral Continuous Suprascapular Nerve Blocks for Bilateral Shoulder Hemiarthroplasty
We report a novel case of a patient undergoing a bilateral shoulder hemiarthroplasty for chronic bilateral shoulder dislocations with proximal humeral fractures. Bilateral selective suprascapular nerve catheters were placed preoperatively with the intent to provide continuous local anesthetic-based analgesia while sparing diaphragmatic function. Postoperative respiratory mechanics were relatively spared while numerical rating scale pain scores were suggestive of analgesic benefit. (Source: A&A Case Reports)
Source: A&A Case Reports - September 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Continuous Noninvasive Hemodynamic Monitoring in an Infant With Tetra-Amelia
We describe the use of a finger cuff blood pressure system for continuous noninvasive blood pressure monitoring in an infant with near-complete tetra-amelia undergoing laparoscopic gastrostomy tube placement. This case suggests the potential use of such a blood pressure monitoring system for other patients with comparable deformities. (Source: A&A Case Reports)
Source: A&A Case Reports - September 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Paraplegia After Thoracic Epidural Steroid Injection
We present a case of a patient who developed an epidural hematoma and subsequent paraplegia despite strict adherence to these guidelines. Although new guidelines serve to direct practice, risks of devastating neurologic complications remain as evidenced by our case. (Source: A&A Case Reports)
Source: A&A Case Reports - September 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research