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-neck acce...
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 survey...
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
A Case Report of Bilateral Phrenic Nerve Dysfunction After Unilateral Supraclavicular Brachial Plexus Block: Unveiling Preexisting Diaphragmatic Dysfunction
A 48-year-old woman with a history of cardiac surgery developed severe dyspnea and anxiety following right-sided supraclavicular nerve block for hand surgery. In this case, right phrenic nerve blockade from a supraclavicular block unmasked a subclinical hemidiaphragmatic paresis from phrenic nerve injury on the left, the latter likely due to previous cardiac surgery. When performing brachial plexus block at or above the clavicle, particularly for prior cardiothoracic surgical patients, anesthesiologists can easily, quickly, and inexpensively use point-of-care ultrasound to assess whether any degree of phrenic nerve dysfunc...
Source: A&A Case Reports - April 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Hypokalemic Periodic Paralysis Masquerading as a Compressive Neuraxial Lesion Following Lumbar Epidural Placement in a Parturient: A Case Report
We report the management of a parturient with undiagnosed hypokalemic periodic paralysis (HOKPP) who underwent epidural analgesia for labor, complicated by an unintentional dural puncture, and the eventual use of epidural anesthesia for cesarean delivery. Following discharge, she represented with lower extremity paresis. After being evaluated for a compressive neuraxial lesion, she made a full recovery following potassium repletion. The obstetric anesthetic implications for patients with HOKPP and how this disorder impacts the evaluation of acute motor weakness in the immediate postpartum period in a patient who recently r...
Source: A&A Case Reports - April 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Acute Intraoperative Hypoxemia During Right Pneumonectomy—The Heart and Lung Interaction: A Case Report
A 75-year-old woman with a history of right-upper lobectomy for adenocarcinoma presented for a right completion pneumonectomy due to 2 new fluorodeoxyglucose-avid densities on the remaining lung. After uneventful anesthetic induction and surgical resection with modest blood loss, the patient developed refractory hypoxemia on emergence without significant hemodynamic changes. Despite delivery of fraction of inspired oxygen (Fio2) = 1.0, confirmed position of the double-lumen tube, and exclusion of common causes of hypoxemia, hypoxemia persisted. An emergent transesophageal echocardiogram revealed a significant intracardiac ...
Source: A&A Case Reports - April 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Ultrasound as a Useful Tool in Hydrocephalus Management During Pregnancy: A Case Report
A 38-year-old pregnant woman in her 24th week of gestation was admitted to our neurosurgical intensive care unit with a 5-cm cerebellar hemangioblastoma and acute hydrocephalus. Initial management included the placement of an external ventricular drain to prevent neurological deterioration. Five days after the initial diagnosis, the patient successfully underwent a neurosurgical intervention to remove the lesion. Transcranial ultrasound was used to determine the optimal ventricular drain level and facilitate weaning, bypassing the need for cerebral computed tomography and cerebral magnetic resonance imaging, which would ha...
Source: A&A Case Reports - April 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Tracheal Dilatation of an Idiopathic Subglottic Stenosis in a Near-Term Parturient at 36 Weeks of Gestation Using SponTaneous Respiration Using Intravenous Anesthesia and Hi-Flow Nasal Oxygen: A Case Report
Hi-flow nasal oxygen (HFNO) has revolutionized tubeless field anesthesia for airway surgery without the complications of jet ventilation. However, its use in third trimester parturients undergoing open airway surgery has been limited to an apneic technique (Transnasal Humidified Rapid-Insufflation Ventilatory Exchange [THRIVE]) in current publications. We used SponTaneous Respiration using IntraVEnous anesthesia and Hi-flow nasal oxygen (STRIVE Hi) in the management of tracheal dilatation in a near-term parturient at 36 weeks of gestation. Transferring this established protocol for spontaneous ventilation in the obstructed...
Source: A&A Case Reports - April 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Cardiac Arrest due to Failed Pacemaker Capture After Peripheral Nerve Blockade With Levobupivacaine: A Case Report
We describe a patient with a pacemaker who developed cardiac arrest shortly after ultrasound-guided rectus sheath block for postoperative analgesia. The cause of cardiac arrest was capture failure due to an increased pacing threshold, and the patient was promptly treated by increasing the pacing amplitude. Local anesthetics used for rectus sheath block might have affected the pacing threshold and caused pacing capture failure, since local anesthetics can block cardiac sodium channels. Anesthesiologists should recognize the risk of pacemaker capture failure when a large amount of local anesthetic is given to patients with a...
Source: A&A Case Reports - April 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Anesthetic Management of a Child With Rapid-Onset Dystonia-Parkinsonism (DYT12-ATP1A3): A Case Report
We report the case of a 14-year-old patient diagnosed with rapid-onset dystonia-parkinsonism who was scheduled for injection of botulinum toxin in his upper limbs under general anesthesia. To our knowledge, there is no previous report about the anesthetic management of patients with rapid-onset dystonia-parkinsonism. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Delayed Obstructive Hydrocephalus After Cardiac Surgery With Cardiopulmonary Bypass in a Patient With Cerebellar Infarction: A Case Report
We present a case of obstructive hydrocephalus that developed on day 8 in a patient with cerebellar infarction. A 39-year-old man with cerebellar infarction caused by myocardial infarction–related intraventricular thrombus underwent left ventricular thrombectomy under cardiopulmonary bypass. He was lucid postoperatively, but his consciousness was diminished on day 8 because of obstructive hydrocephalus. Cerebral edema due to cardiopulmonary bypass may contribute to delayed onset of obstructive hydrocephalus, especially in patients with large-sized cerebellar infarction. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
January 1, 2020 through December 31, 2020
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Guest Reviewers Source Type: research
Half-Turned Truncal Switch Surgery for Dextro-Transposition of Great Arteries With Ventricular Septal Defect and Pulmonary Stenosis: Role of Intraoperative Echocardiography
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Echo Rounds Source Type: research
