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

An Unusual Postoperative Neuropathy: Foot Drop Contralateral to the Lateral Decubitus Position
Postoperative neuropathy is often related to surgical positioning or improper padding during surgery. However, other causes should be considered, particularly when the deficit does not correlate with a positioning error. A case is presented of a 15-year-old girl who experienced postoperative foot drop contralateral to the lateral decubitus position. Further evaluation led to a clinical diagnosis of hereditary neuropathy with liability to pressure palsies that predisposed the patient to the injury. Anesthesiologists should suspect hereditary neuropathy with liability to pressure palsies in patients presenting for multiple n...
Source: A&A Case Reports - September 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

A Case of Pseudocholinesterase Deficiency Resulting From Malnutrition
We present the case of a patient with a history of bariatric surgery and severe malnutrition who subsequently developed prolonged neuromuscular blockade after succinylcholine administration. She had markedly decreased pseudocholinesterase levels at the time of the incident, but her motor function returned to normal with supportive care. After aggressive nutritional support over multiple weeks, her pseudocholinesterase levels drastically improved. For those patients in a poor nutritional state who experience an unexpected episode of apnea or prolonged neuromuscular blockade, practitioners must always consider malnutrition-i...
Source: A&A Case Reports - September 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Intraoperative Monitoring of Pulmonary Artery Physiology With Transesophageal Echocardiography in a Patient With an Extensive Pulmonary Aneurysm Undergoing Partial Nephrectomy
Surgical patients with pulmonary hypertension present a significant challenge to the anesthesiologist. Continuous perioperative monitoring of pulmonary artery (PA) pressure is recommended and most often accomplished with a PA catheter. Placement of a PA catheter may be difficult or contraindicated, and in these cases, transesophageal echocardiography is a useful alternative to monitor dynamic PA physiology. In this case, we used intraoperative transesophageal echocardiography to detect changes in peak PA pressure and guide clinical treatment in a patient with pulmonary hypertension and an extensive PA aneurysm undergoing p...
Source: A&A Case Reports - September 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Cerebrospinal Fluid-Cutaneous Fistula After Continuous Spinal Catheter in an Obstetric Patient
A 23-year-old woman at 41 weeks and 6 days estimated gestational age underwent continuous spinal analgesia for labor after a recognized, unintended dural puncture. Excellent analgesia was maintained throughout labor and vaginal delivery, the intrathecal catheter was left in situ for 24 hours postpartum, and the catheter was subsequently removed without apparent complication. On physical examination during her anesthesia postoperative visit, clear fluid was noted to be slowly draining from the catheter insertion site. Although she denied all symptoms associated with a dural puncture, including headache, a cerebrospinal flui...
Source: A&A Case Reports - September 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Fatal Intramyocardial Hemorrhage After Pericardiotomy in a Patient With von Willebrand Disease
Patients with large pericardial effusions and possible tamponade undergoing general anesthesia for pericardial drainage are generally thought to be at a highest risk of cardiovascular collapse before drainage of the effusion. Here, we report a case of extensive and fatal intramyocardial hemorrhage after drainage of a pericardial effusion in a patient with von Willebrand disease. (Source: A&A Case Reports)
Source: A&A Case Reports - September 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Calm Before the Storm: An Uncomplicated Epicardial Lead Extraction Resulting in DIC and Patient Demise
A previously stable 77-year-old man with significant cardiac history underwent an uneventful extraction of a Citrobacter-infected and eroded pacemaker lead. His postoperative course was acutely complicated by respiratory failure and quickly progressed into disseminated intravascular coagulation, acute renal failure, shock liver, and ventricular tachycardic arrest. I believe that this is the first case report of such a drastic turn of events after a routine pacemaker lead extraction. (Source: A&A Case Reports)
Source: A&A Case Reports - August 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Removal of an Entrapped Lumbar Drain After Thoracic Endovascular Aortic Repair
We report a case of an entrapped lumbar drain after thoracic endovascular aortic repair. Computed tomography imaging of the lumbar spine with 3-dimensional reformatting was critical in determining where the drain was entrapped and assisted with its removal. Induction of general anesthesia to reduce muscle spasms and extreme flexion of the lumbar spine also facilitated removal. This case demonstrates a safe step-by-step approach that was used for removing an entrapped drain. (Source: A&A Case Reports)
Source: A&A Case Reports - August 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Management of Innominate Vein Rupture During Superior Vena Cava Angioplasty
Although vessel perforation rarely occurs during percutaneous transluminal angioplasty of a central venous stenosis, it can be a rapidly fatal complication when accompanied by pericardial tamponade. The present case report details our experience with this dangerous complication. It also highlights the risk factors for and the pathogenesis of central venous stenosis, the clinical findings associated with inadvertent vessel perforation during an intervention, and anesthetic management strategies for pericardial tamponade resulting from vessel perforation. (Source: A&A Case Reports)
Source: A&A Case Reports - August 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Anesthetic Management During Emergency Surgical Ligation for Carotid Blowout Syndrome
We describe the anesthetic strategy and the thromboelastometry (ROTEM®)-guided massive transfusion protocol. (Source: A&A Case Reports)
Source: A&A Case Reports - August 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Life-Threatening Lactation or “Bovine” Ketoacidosis: A Case Report
We present a case of life-threatening lactation-related ketoacidosis in a patient 9 weeks postpartum, who presented to the emergency department with an arterial pH of 6.88, HCO3− of 5.8 mmol/L and blood ketone level of 5.8 mmol/L. Treatment consists of aggressive glucose loading, triggering supraphysiologic endogenous insulin release, and subsequent inhibition of ketone body formation. (Source: A&A Case Reports)
Source: A&A Case Reports - August 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Kawasaki Disease With Giant Coronary Aneurysms Requiring a Ventricular Assist Device to Separate From Extracorporeal Membrane Oxygenation: Coronary Issues Can Be a Pediatric Problem Too!
We present a case of a 31-month-old patient requiring a left ventricular assist device after thrombosis of giant coronary aneurysms led to ischemic cardiomyopathy. At the termination of the surgical procedure, we encountered 2 periods of ventricular assist device dropout requiring intervention. With the increase in the number of pediatric patients with assist devices, we review the basic care for a patient requiring emergent surgery. (Source: A&A Case Reports)
Source: A&A Case Reports - August 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Institutional Policy Changes to Prevent Cardiac Toxicity Associated With Bupivacaine Penile Blockade in Infants
Dorsal penile nerve block is a widely used method of analgesia for infants undergoing penile surgery. Because of its potency, extended duration of action, and lack of vasoconstriction, bupivacaine remains the most commonly used local anesthetic. Rapid systemic absorption of bupivacaine, however, has been associated with profound central nervous system and cardiovascular side effects, including cardiac arrest. As determined by retrospective medical record analysis, the incidence of complications associated with dorsal penile blockade in our institution was 0.075%. This was significantly higher than previously reported promp...
Source: A&A Case Reports - August 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Double Invasive Blood Pressure Monitoring for Cesarean Delivery in a Pregnant Woman With Aortic Coarctation
We report a case of severe uncorrected congenital aortic coarctation in a 31-year-old symptomatic pregnant woman at 29 weeks of gestation who underwent successful cesarean delivery with an epidural anesthetic technique. Transthoracic echocardiography showed a gradient of 75 mm Hg. To avoid undiagnosed arterial hypotension and inadequate uteroplacental flow distal to the coarctation, double (radial and femoral) invasive arterial blood pressure measurement was used to monitor both pre- and postcoarctation arterial blood pressure. (Source: A&A Case Reports)
Source: A&A Case Reports - August 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

The Anesthetic Implications of Aqueous Drainage Devices and Glaucoma: A Report of a Patient Undergoing Urgent Prone Cervical Decompression and Fusion
We present the case of a patient with recalcitrant glaucoma treated with an Ahmed Glaucoma Valve who underwent urgent prone surgery. Anesthetic implications of aqueous drainage devices and glaucoma are discussed, and recommendations are made. (Source: A&A Case Reports)
Source: A&A Case Reports - August 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

A Web-Based Operating Room Management Educational Tool
In 2010, our department instituted a nonclinical, administrative rotation in operating room management for anesthesiology residents. Subsequently, we mandated the rotation for all senior anesthesiology residents in 2013. In 2014, under the auspices of the American Society of Anesthesiologists, we developed a web-based module covering the basics of finance, accounting, and operating room management. A multiple-choice test was given to residents at the beginning and end of the rotation, and we compared the mean scores between residents who took the traditional course and residents who took the web-based module. We found no s...
Source: A&A Case Reports - August 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

A Rare Case of Transverse Sinus Venous Thrombosis Simulating Postdural Puncture Headache After Cervical Epidural Injection
We report a unique case in which all subjective and objective findings indicated the diagnosis of PDPH. However, the patient failed appropriate conservative and interventional management. Therapeutic failure prompted further investigation to establish the correct diagnosis of cerebral venous sinus thrombosis. Cerebral venous sinus thrombosis is a rare, difficult to diagnose, but potentially lethal disorder with nonspecific and variable clinical presentations, including headache and focal neurological deficits. Performing magnetic resonance imaging and magnetic resonance venogram should be considered early, especially in pa...
Source: A&A Case Reports - August 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Recognition and Management of Perioperative Stroke in Hospitalized Patients
We sought to characterize stroke management and outcomes in a postoperative population. By using the electronic medical records, we identified 39 patients suffering perioperative stroke after noncardiac and nonneurosurgical procedures for whom documentation of management and outcomes was available. Thirty-three strokes occurred during admission, whereas 6 occurred after discharge and were recognized upon return to the hospital. Perioperative stroke was associated with delayed recognition, infrequent intervention, and significant rates of morbidity and mortality, suggesting the need for improved screening and more rapid tre...
Source: A&A Case Reports - August 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Where Is the Lesion in Posterior Ischemic Optic Neuropathy Occurring After Prone Spine Surgery?
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - July 15, 2016 Category: Anesthesiology Tags: Case Reports: Letter to the Editor Source Type: research

High-Dose Desflurane for Tocolysis During Intrapartum Myelomeningocele Repair in a Patient With Post-Adriamycin Cardiomyopathy
We present a case of a 32-year-old parturient with a history of mild cardiomyopathy undergoing open fetal myelomeningocele repair. Phenylephrine and dopamine infusions helped maintain hemodynamic stability at 18% desflurane, while cardiac function was monitored with transthoracic echocardiography. This case is notable for the unknown risk of using high-dose desflurane with a preexisting cardiomyopathy and raises the question of the acceptable maternal risk in the setting of fetal surgery. (Source: A&A Case Reports)
Source: A&A Case Reports - July 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Otocephaly Complex: Case Report, Literature Review, and Ethical Considerations
In this report, we discuss the medical and ethical issues related to the care of a newborn with this frequently fatal condition. (Source: A&A Case Reports)
Source: A&A Case Reports - July 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Dermographism: A Rare Cause of Intraoperative Hypotension and Urticaria
A 54-year-old man with dermographism presented for spine surgery, and shortly after induction of anesthesia, he experienced severe hypotension and urticaria, resulting in cancellation of the case on suspicion of allergic reaction. For subsequent ventral hernia repair, a perioperative management strategy was devised, which resulted in an uneventful perioperative course. This case report is the first to demonstrate severe intraoperative hypotension and urticaria from dermographism. We discuss the strategy that made the subsequent surgery a success and provide guidance for practitioners who face a patient with a severe form o...
Source: A&A Case Reports - July 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Continuous Suprascapular Nerve Block With a Perineural Catheter for Reverse Shoulder Arthroplasty Rescue Analgesia in a Patient With Severe Chronic Obstructive Pulmonary Disease
We report a successful case of the use of a suprascapular nerve block with continuous programmed intermittent bolus perineural analgesia in a patient with severe chronic obstructive pulmonary disease who underwent reverse open shoulder arthroplasty. (Source: A&A Case Reports)
Source: A&A Case Reports - July 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Transfusion-Free Calvarial Vault Reconstruction Using Multimodal Blood Conservation Strategies in Two Pediatric Jehovah’s Witness Patients With Craniosynostosis
We present 2 patients of the Jehovah’s Witness faith affected with craniosynostosis who underwent transfusion-free calvarial vault reconstructions using several blood conservation approaches, including the use of antifibrinolytic ε-aminocaproic acid. (Source: A&A Case Reports)
Source: A&A Case Reports - July 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Leveraging the Preoperative Clinic to Engage Older Patients in Shared Decision Making About Complex Surgery: An Illustrative Case
We describe a case of an older adult presenting for complex surgery in which the preoperative anesthesia clinic visit was used to facilitate involvement of the geriatrics service. This multidisciplinary approach allowed for re-evaluation and reiteration of risks and benefits, in-depth discussion of the patient’s values and goals, and recommendations for care teams downstream in the patient’s surgical pathway to ensure treatment consistent with patient goals and clinical recommendations. (Source: A&A Case Reports)
Source: A&A Case Reports - July 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Ventriculoperitoneal Shunt Insertion Under Monitored Anesthesia Care in a Patient With Severe Pulmonary Hypertension
A 32-year-old man with severe pulmonary arterial hypertension and Eisenmenger syndrome secondary to congenital ventricular septal defects presented for ventriculoperitoneal shunt insertion. Consultation between surgical and anesthesia teams acknowledged the extreme risk of performing this case, but given ongoing symptoms related to increased intracranial pressure from a large third ventricle colloid cyst, the case was deemed urgent. After a full discussion with the patient, including an explanation of anesthetic expectations and perioperative risks, the case was performed under monitored anesthesia care. Anesthetic managem...
Source: A&A Case Reports - July 15, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Impella™ Left Ventricular Assist Device for Acute Peripartum Cardiomyopathy After Cesarean Delivery
Peripartum cardiomyopathy is a rare form of heart failure with significant perioperative implications. In this case report, we describe a 34-year-old gravida 5, parity 3, patient who was admitted for an elective cesarean delivery. During the delivery, the patient developed sudden cardiac arrest and was emergently intubated in the operating room. An emergent transesophageal echocardiogram revealed a left ventricular ejection fraction of 10% with global biventricular hypokinesis. Urgent multidisciplinary consultations led to the rapid implementation of the Impella™ 2.5 for ventricular support. The patient recovered ven...
Source: A&A Case Reports - July 1, 2016 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research