Radiofrequency Scanning for Retained Surgical Items Can Cause Electromagnetic Interference and Pacing Inhibition if an Asynchronous Pacing Mode Is Not Applied
We present a case of an RF system used with a temporary pacemaker resulting in asystole. With the use of RF devices becoming widespread, it is important for all operating room personnel to recognize the potential for pacemaker interference from RF scanning devices and the requirements for asynchronous pacing when these devices are in use. (Source: A&A Case Reports)
Source: A&A Case Reports - March 15, 2016 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

Editorial Comment: Manufacturer’s Response
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - March 15, 2016 Category: Anesthesiology Tags: Editorials: Editorial Source Type: research

The Unstated Murphy’s Law of the Operating Room: If Something Goes Wrong, Blame Anesthesia
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - March 15, 2016 Category: Anesthesiology Tags: Editorials: Editorial Source Type: research

In Response
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2016 Category: Anesthesiology Tags: Letters to the Editor: Letter to the Editor Source Type: research

Preoperative Focused Cardiac Ultrasound—Time for Implementation?
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2016 Category: Anesthesiology Tags: Letters to the Editor: Letter to the Editor Source Type: research

Perioperative Care Coordination Measurement: A Tool to Support Care Integration of Pediatric Surgical Patients
The relationship of care coordination activities and outcomes to resource utilization and personnel costs has been evaluated for a number of pediatric medical home practices. One of the first tools designed to evaluate the activities and outcomes for pediatric care coordination is the Care Coordination Measurement Tool (CCMT). It has become widely used as an instrument for health care providers in both primary and subspecialty care settings. This tool enables the user to stratify patients based on acuity and complexity while documenting the activities and outcomes of care coordination. We tested the feasibility of adapting...
Source: A&A Case Reports - March 1, 2016 Category: Anesthesiology Tags: Case Reports: Education Source Type: research

Prothrombin Complex Concentrate and Methylene Blue for Treatment of Coagulopathy and Vasoplegia in a Pediatric Heart Transplant Patient
We describe a case in which these conditions were successfully treated with no thrombotic complications and minimal need of vasopressors for hemodynamic stability. (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2016 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

Unintentional Infusion of Phenylephrine into the Epidural Space
We describe a patient who received an unintentionally prolonged epidural infusion of phenylephrine. The patient experienced no major morbidity. However, this case highlights the continuing problem of wrong-route drug administration and the urgent need to adopt route-specific connections. (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2016 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

Misconnections in the Critically Ill: Injection of High-Dose Gadolinium into an External Ventricular Drain
We report an unfortunate case of accidental administration of intrathecal gadolinium through an external ventricular drain in a postcraniotomy patient during magnetic resonance imaging of the brain. The incident occurred after the venous contrast line was connected mistakenly to the ventricular drainage catheter. The patient subsequently developed confusion, aphasia, and right facial droop with new computed tomography evidence of diffuse cerebral edema and stroke. Review of the magnetic resonance image revealed the inappropriate presence of subarachnoid gadolinium. Despite all interventions, the patient developed irreversi...
Source: A&A Case Reports - March 1, 2016 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

The Critical Importance of Hepatic Venous Blood Flow Doppler Assessment for Patients in Shock
Hepatic venous blood flow can be easily obtained using bedside ultrasound with either transthoracic or transesophageal echocardiography. Six critically ill patients with shock associated with absent or significantly reduced hepatic venous blood flow in the presence of normal or increased pulmonary venous flow are presented. In all these patients, the etiology of shock was secondary to increased resistance to venous return from either an intraabdominal process or through extrinsic or intrinsic occlusion of the proximal inferior vena cava or right atrium. These shock situations are secondary to increased resistance to venous...
Source: A&A Case Reports - March 1, 2016 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

Blood-Conservation Strategies in a Blood-Refusal Parturient with Placenta Previa and Placenta Percreta
We present a 35-year-old, gravida 3, para 1, Jehovah’s Witness at 35 weeks of gestation with placenta percreta, who underwent cesarean delivery and delayed hysterectomy. A multidisciplinary team developed a plan, including the use of perioperative erythropoietin and IV iron dextran, intraoperative acute normovolemic hemodilution, cell salvage, tranexamic acid, and uterine artery embolization. This strategy was successful in avoiding the need for allogeneic transfusion and ensuring an uneventful recovery after both surgical procedures. (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2016 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

J’Accuse! Failure to Prevent Epidural and Spinal Catheter Misconnections
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2016 Category: Anesthesiology Tags: Editorials: Editorial Source Type: research

Plagiarism in Personal Statements of Anesthesiology Residency Applicants
Plagiarism by residency applicants in their personal statements, as well as sites that sell personal statements, have been described, and led in 2011 to advice to avoid plagiarism and the caution that plagiarism detection software was available. We screened personal statements of 467 anesthesiology residency applicants from 2013–2014 using Viper Plagiarism Scanner software, and studied them for plagiarism. After quotes and commonly used phrases were removed, 82 statements contained unoriginal content of 8 or more consecutive words. After the study, 13.6% of personal statements from non-United States medical school gr...
Source: A&A Case Reports - February 15, 2016 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

Two Serious Complications of Peripherally Inserted Central Catheters Indicating the Need to Formalize Training for Placing Central Venous Vascular Access Devices
We describe 2 serious complications that resolved without sequelae. Both complications occurred in the context of limited provider competence. We conclude that vascular access is more than “just” placing a catheter; it can have serious clinical impact and has evolved into a specialist skill. With increasing use of intravascular catheters, the need for a formalized training becomes urgent. (Source: A&A Case Reports)
Source: A&A Case Reports - February 15, 2016 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

The Resident Academic Project Program: A Structured Approach to Inspiring Academic Development During Residency Training
We report the successful implementation of structured resident academic projects in our Department of Anesthesiology at the Penn State Hershey Medical Center. Beginning with the graduating class of 2010, we adopted an expectation that each resident complete a project that results in a manuscript of publishable quality. Defining a clear timeline for all steps in the project and providing research education, as well as the necessary infrastructure and ongoing support, has helped grow the academic productivity of our anesthesia residents. (Source: A&A Case Reports)
Source: A&A Case Reports - February 15, 2016 Category: Anesthesiology Tags: Case Reports: Education Source Type: research

Anesthetic Implications for Tracheal Injury During Bronchoscopy-Guided Percutaneous Dilational Tracheostomy
We present a case of a critically ill patient undergoing percutaneous dilation tracheostomy complicated by tracheal wall injury and airway loss. The airway was successfully conservatively managed as well as the tracheal injury. Anesthetic implications, safety, and management options as well as recommendations are reviewed. (Source: A&A Case Reports)
Source: A&A Case Reports - February 15, 2016 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

An Uncommon Complication with a Supraglottic Airway: The King LT
General anesthesia was administered in an 18-year-old man for removal of hardware from his right knee using a King Laryngeal Tube supraglottic airway. An hour after extubation, he reported inability to swallow with no respiratory distress. Examination showed an edematous uvula, which took 3 days to subside with anti-inflammatory medication. During the positioning of the King Laryngeal Tube, it was pulled back to ensure adequate ventilation. The inflated cuff could have dragged the uvula and folded it on itself, leading to venous congestion and edema. (Source: A&A Case Reports)
Source: A&A Case Reports - February 15, 2016 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

Successful Anesthesia Management for 2-Stage Surgical Procedure of a Refractory Tracheogastric Tube Fistula After Esophagectomy
We present a case report of the anesthetic management of a patient having 2-stage surgical repair combined with endoscopic mucosal resection for a giant carinal tracheogastric tube fistula. The first stage was separation of the gastric tube above the fistula with spontaneous breathing under local anesthesia and sedation. The second stage was complete separation and reconstruction of the digestive tract under epidural and general anesthesia with spontaneous breathing and pressure support before insertion of a decompression tube. (Source: A&A Case Reports)
Source: A&A Case Reports - February 15, 2016 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

Overinflation of a King LT Extraglottic Airway Device Mimicking Ludwig’s Angina
In this report, we describe the case of a young female with Down syndrome who presented to the anesthesia service after pulseless electrical activity arrest with a King LT(S)-D extraglottic airway device in situ. She had multiple predictors of difficult intubation, including what appeared to be a submental mass consistent with Ludwig’s angina. She went on to receive an urgent tracheotomy because of those predictors but had full resolution of the submental mass on removal of the extraglottic airway device, which had been overinflated at the time of insertion. We outline the various techniques to establish a definitive...
Source: A&A Case Reports - February 15, 2016 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

Direct Laryngoscopy and Endotracheal Intubation Complicated by Anterior Tracheal Laceration Secondary to Protrusion of Preloaded Endotracheal Tube Stylet
We present the case of a 68-year-old man who developed an anterior tracheal tear after routine endotracheal intubation, most likely occurring secondary to protrusion of a factory-preloaded stylet beyond the distal orifice of the endotracheal tube. Tracheal disruption should be considered in any patient with subcutaneous emphysema and respiratory distress after tracheal extubation and confirmed with bronchoscopy. Conservative management may be appropriate for those with small tears, hemodynamic stability, and the ability to isolate the tear from positive pressure ventilation. (Source: A&A Case Reports)
Source: A&A Case Reports - February 15, 2016 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

The Impact of a Resident Communication Skills Curriculum on Patients’ Experiences of Care
Despite the high impact of lapses in communication skills on patient care, these skills are often not explicitly taught in residency training programs. We implemented a simulation and web-based curriculum in communication for anesthesia residents and used a patient survey adapted from the Four Habits Coding Scheme to detect changes in patient feedback on residents’ communication skills after the curricular intervention. Postintervention mean ratings of residents for the overall survey were higher than preintervention mean ratings. Future research will focus on assessing the curriculum’s effectiveness and explor...
Source: A&A Case Reports - February 1, 2016 Category: Anesthesiology Tags: Case Reports: Perioperative Services Source Type: research

Emergent Airway Management of an Uncooperative Child with a Large Retropharyngeal and Posterior Mediastinal Abscess
We present the case of a 12-year-old girl with mediastinitis and tracheal compression and anterior displacement from a large retropharyngeal and posterior mediastinal abscess secondary to traumatic esophageal perforation, who received successful awake nasal fiberoptic intubation. Anesthesiologists must be prepared for airway emergencies in uncooperative patients, especially children, but there is controversy concerning the use of sedation. (Source: A&A Case Reports)
Source: A&A Case Reports - February 1, 2016 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

Anesthesia for Potts Shunt in a Child with Severe Refractory Idiopathic Pulmonary Arterial Hypertension
We present the first description of anesthetic management of a child undergoing surgical Potts shunt for pulmonary arterial hypertension and summarize the multiple, unique intraoperative considerations. (Source: A&A Case Reports)
Source: A&A Case Reports - February 1, 2016 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

Elephant Trunk–Like Teratoma of the Face with Compromised Airway in an Infant with Complex Congenital Cardiac Defects: An Anesthetic Challenge
We report on the anesthetic management of a female infant with a facial teratoma and single-ventricle physiology undergoing a cardiac palliative procedure where securing a definitive airway with minimal hemodynamic instability was the immediate requirement. (Source: A&A Case Reports)
Source: A&A Case Reports - February 1, 2016 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

Harlequin Syndrome After Thoracic Paravertebral Block
We present a case of Harlequin syndrome without Horner syndrome in a patient with unilateral right-sided facial flushing that started shortly after a left-sided thoracic paravertebral nerve block for a mastectomy. We discuss the interruption of the sympathetic and parasympathetic nervous system and the levels of spinal nerve block associated with a thoracic paravertebral nerve block. (Source: A&A Case Reports)
Source: A&A Case Reports - February 1, 2016 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

Unexplained Profound Hypoglycemia After Vocal Fold Lipoinjection
We present a case of a 66-year-old man with long-lasting hoarseness secondary to vocal fold atrophy, who underwent an uneventful bilateral vocal fold injection with autologous fat. While in the recovery area, he experienced profuse sweating approximately 30 minutes after the surgical procedure. His blood glucose value was measured at 24 mg/dL, and plasmatic insulin level was 246 mU/L. To our knowledge, this is the first reported case of a systemic side effect after vocal fold lipoinjection. (Source: A&A Case Reports)
Source: A&A Case Reports - February 1, 2016 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

Editorial Comment on Unexplained Profound Hypoglycemia After Vocal Fold Lipoinjection
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - February 1, 2016 Category: Anesthesiology Tags: Editorials: Editorial Source Type: research

In Response
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - January 15, 2016 Category: Anesthesiology Tags: Letters to the editor: Letter to the Editor Source Type: research

Ultrasound-Guided Quadratus Lumborum Blocks: Definition of the Clinical Relevant Endpoint of Injection and the Safest Approach
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - January 15, 2016 Category: Anesthesiology Tags: Letters to the editor: Letter to the Editor Source Type: research

First Job Search of Residents in the United States: A Survey of Anesthesiology Trainees’ Interest in Academic Positions in Cities Distant from Previous Residences
We surveyed anesthesiology residents to evaluate the predictive effect of prior residence on desired location for future practice opportunities. One thousand five hundred United States anesthesiology residents were invited to participate. One question asked whether they intend to enter academic practice when they graduate from their residency/fellowship training. The analysis categorized the responses into “surely yes” and “probably” versus “even,” “probably not,” and “surely no.” “After finishing your residency/fellowship training, are you planning to look ...
Source: A&A Case Reports - January 15, 2016 Category: Anesthesiology Tags: Case Reports: Education Source Type: research

Management of Near-Complete Airway Obstruction Caused by a Vallecular Cyst in an Infant Using a Tongue Tip Traction Suture
We report the use of a preoperative oral fiberoptic assessment of the airway, use of a tongue stitch, and manipulation of a flexible nasal fiberoptic bronchoscope to secure the airway. Keeping the patient breathing spontaneously with low-dose ketamine also facilitated successful tracheal intubation. (Source: A&A Case Reports)
Source: A&A Case Reports - January 15, 2016 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

Acute Retroperitoneal Hematoma After Psoas Catheter Placement in a Patient with Myeloproliferative Thrombocytosis and Aspirin Therapy
We present the case of a patient with a history of myeloproliferative thrombocytosis receiving aspirin therapy who underwent total hip arthroplasty with preoperative psoas catheter placement complicated by immediate development of a large retroperitoneal hematoma. It is likely that the combination of aspirin therapy and thrombocytosis paradoxically placed the patient at increased risk for hemorrhagic complications. Regional techniques should be used cautiously in patients with myeloproliferative disorders, even in the presence of supraphysiologic platelet counts. (Source: A&A Case Reports)
Source: A&A Case Reports - January 15, 2016 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

The Effect of Peribulbar Block with General Anesthesia for Vitreoretinal Surgery in Premature and Ex-Premature Infants with Retinopathy of Prematurity
We describe our experience of peribulbar block in 24 infants who underwent vitreoretinal surgery for retinopathy of prematurity. None of our patients had postoperative apnea or required neonatal intensive care admission. A possible opioid and muscle relaxant–sparing effect of peribulbar block might have reduced the incidence of postoperative complications. (Source: A&A Case Reports)
Source: A&A Case Reports - January 15, 2016 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

Symptoms of Central Anticholinergic Syndrome After Glycopyrrolate Administration in a 5-Year-Old Child
Anesthesia-related central anticholinergic syndrome (CAS) is most commonly associated with administration of atropine or scopolamine, whereas glycopyrrolate is an extremely rare cause of CAS. Here, we report a case of CAS in a 5-year-old boy admitted to the intensive care unit. Immediately after the administration of glycopyrrolate, he became agitated and developed apnea, hypertension, tachycardia, and anuria. Although the present case describes a rare cause of CAS, it is an important reminder of an iatrogenic condition that is presumably underdiagnosed in the operating theater as well as the intensive care unit. (Source: ...
Source: A&A Case Reports - January 15, 2016 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

Intraoperative Management of Increased Intraocular Pressure in a Patient with Glaucoma Undergoing Robotic Prostatectomy in the Trendelenburg Position
We describe a case of successful intraoperative management of increased IOP in a patient with glaucoma undergoing robotic radical prostatectomy while in steep Trendelenburg position. (Source: A&A Case Reports)
Source: A&A Case Reports - January 15, 2016 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

Intraoperative Management of Increased Intraocular Pressure in a Patient with Glaucoma Undergoing Robotic Prostatectomy in Trendelenburg Position
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - January 15, 2016 Category: Anesthesiology Tags: Editorials: Editorial Source Type: research

Liver Transplantation Using Dexmedetomidine in a Patient with a History of Takotsubo Cardiomyopathy
We describe the use of dexmedetomidine in a patient with a history of takotsubo cardiomyopathy undergoing living-donor liver transplantation. (Source: A&A Case Reports)
Source: A&A Case Reports - January 1, 2016 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

Variant Neurogenic Stunned Myocardium in a Young Female After Subarachnoid Hemorrhage
We describe characteristics and outcomes of neurogenic stunned myocardium in this young patient with arteriovenous malformation-associated aneurysmal subarachnoid hemorrhage. (Source: A&A Case Reports)
Source: A&A Case Reports - January 1, 2016 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

Reverse Apical Ballooning Echocardiographic Pattern in Eclampsia-Related Cardiomyopathy
The diagnosis of heart failure during pregnancy has important management implications for the parturient and her fetus. A 19-year-old primigravida developed eclampsia at 29 weeks' gestation. Echocardiography demonstrated normal left ventricular size and ejection fraction of 35% with reverse apical ballooning (reverse takotsubo pattern). Under general anesthesia with invasive monitoring, she underwent urgent cesarean delivery of a preterm infant. Follow-up echocardiography 4 weeks after delivery showed complete normalization of her ejection fraction (56%). This case of eclampsia-related stress-induced cardiomyopathy is a di...
Source: A&A Case Reports - January 1, 2016 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

Prolonged Cardiac Dysfunction After Intraparenchymal Hemorrhage and Neurogenic Stunned Myocardium
We present a case of neurogenic stunned myocardium, discovered intraoperatively after anesthetic induction, in a patient who presented to our operating room with a recent intraparenchymal hemorrhage. We discuss the longitudinal cardiac functional course after neurogenic stunned myocardium. Finally, we discuss the pathophysiology of neurogenic stunned myocardium, as well as its implications for anesthesiologists caring for neurosurgical patients. (Source: A&A Case Reports)
Source: A&A Case Reports - January 1, 2016 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

Perioperative Stress Cardiomyopathy: Case Reports Matter!
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - January 1, 2016 Category: Anesthesiology Tags: Editorials: Editorial Source Type: research

Valsalva Retinopathy: A Rare Complication After General Anesthesia
Sudden visual loss after general anesthesia is a rare and serious complication. Unilateral visual loss can be caused by an increase in pressure in the preretinal veins with subsequent rupture and hematoma formation. Our patient most likely experienced an increase in venous pressure as a consequence of temporarily increased intrapulmonary pressures during a sustained Valsalva maneuver shortly after tracheal intubation. Although surgical correction is available, in almost all cases, no specific therapy is required because the problem completely regresses spontaneously. (Source: A&A Case Reports)
Source: A&A Case Reports - December 15, 2015 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

Severe Acute Respiratory Failure due to Inhalation of Baby Powder and Successfully Treated with Venous-Venous Extracorporeal Membrane Oxygenation
We present a case of accidental inhalation of rice starch powder in a 17-month-old girl, which led to severe acute respiratory distress syndrome responsive to conventional treatment, ultimately requiring venous-venous extracorporeal membrane oxygenation. (Source: A&A Case Reports)
Source: A&A Case Reports - December 15, 2015 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

Airway Management of Incidental Vallecular Cysts in Adults
We describe management of such a case complicated by cyst rupture and intensive care unit admission. A literature review of eligible case reports was conducted, demonstrating an association between incidental vallecular cysts and difficult bag–mask ventilation and laryngoscopy with intraoperative otolaryngology consultation and intervention being common. Anesthetic management recommendations are thus presented, highlighting any conflicts with current difficult airway algorithms. (Source: A&A Case Reports)
Source: A&A Case Reports - December 15, 2015 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

The “Plateau” Phenomenon of Stepwise Extracorporeal Albumin Dialysis Bispectral Index Hepatic Encephalopathy Recovery
The Bispectral Index™ monitor, an electroencephalographic-derived parameter, can quantify hepatic encephalopathy cerebral function recovery and differentiate between West Haven grades 1 to 4. I report a very peculiar “plateau” phenomenon of 3 clear distinct plateaus of stepwise albumin dialysis Bispectral Index hepatic encephalopathy recovery during an 8-hour Molecular Adsorbent Recirculating System™ (MARS™) liver-assist extracorporeal detoxification, manifesting in conjunction with 3 West Haven grade recoveries. In the patients, I observed recovery of cerebral function after hepatic encephalo...
Source: A&A Case Reports - December 15, 2015 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

Cerebral Oximetry Decrease After External Carotid Clamping with Normal Electroencephalography and No Change After Internal Carotid Clamping
We present a case in which, before clamping the left carotid artery during an endarterectomy, the right and left rSO2 measurements were 72% and 74%, respectively. Within 15 seconds of clamping the external carotid artery, the left rSO2 decreased by 8%, yielding right and left rSO2 measurements of 70% and 66%, respectively. No electroencephalogram changes ensued. The internal carotid artery was clamped 1 minute later, whereas the external carotid remained clamped. No electroencephalogram changes were observed. The rSO2 measurements demonstrate that the value of this cerebral oximetry is not determined solely from internal c...
Source: A&A Case Reports - December 15, 2015 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

Hip Hemiarthroplasty in Two Patients with Severe Aortic Stenosis: Ethical Questions from an Anesthesiologist’s Perspective
As the population ages, geriatric patients with preexisting cardiac disease are presenting for noncardiac surgery in escalating numbers. The decision to proceed with surgery in such patients often is multifactorial. With this in mind, we describe 2 patients with severe aortic stenosis who required hip operations: one urgent and one elective. Both patients had different anesthetic plans and did well intraoperatively. However, both patients died postoperatively because of their comorbidities. Although published guidelines are sparse, we hope this report will increase awareness and discussion about caring for geriatric patien...
Source: A&A Case Reports - December 15, 2015 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

The “Fourth Mission”: The Time Commitment of Anesthesiology Faculty for Management Is Comparable to Their Time Commitments to Education, Research, and Indirect Patient Care
Academic anesthesia departments have management responsibilities (e.g., coordinating sedation, directing the operating rooms [ORs], informatics, ongoing professional performance evaluation, staff scheduling, and workroom inventory management). For each of the 64 faculty, a survey sampled 10 weekdays and 4 weekend days of professional activity over N = 56 days. Faculty time in managerial activities was 126% of time spent on education, 107% of time spent in research, and 112% of time spent on mandatory indirect clinical support (e.g., fire safety training). The 95% lower confidence limits calculated using Fieller’s the...
Source: A&A Case Reports - December 1, 2015 Category: Anesthesiology Tags: Case Reports: Education Source Type: research

Use of the Draeger Apollo to Deliver Bilevel Positive Pressure Ventilation During Awake Frontal Craniotomy for a Patient with Severe Chronic Obstructive Pulmonary Disease
We describe the intraoperative use of pressure support mode on the anesthesia machine to deliver noninvasive positive pressure ventilation through a standard anesthesia mask. Given its ease of access and effectiveness, it is our belief that intraoperative BiPAP may reduce hypoxemia and/or hypercarbia in patients with chronic obstructive pulmonary disease and obstructive sleep apnea undergoing moderate to deep sedation. (Source: A&A Case Reports)
Source: A&A Case Reports - December 1, 2015 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research

Compartment Syndrome Resulting from Carbon Monoxide Poisoning
We present a case of compartment syndrome in both lower extremities with accompanying acute renal failure and systemic capillary leakage syndrome because of carbon monoxide poisoning. (Source: A&A Case Reports)
Source: A&A Case Reports - December 1, 2015 Category: Anesthesiology Tags: Case Reports: Clinical Care Source Type: research