A Case Report of the Anesthetic Management of a Parturient With Congenital Hypofibrinogenemia and Complete Placenta Previa
A multidisciplinary approach among the obstetric, hematological, pharmaceutical, nursing, and anesthetic team proved essential for the successful peripartum management of a gravida 3, para 2 female with a new diagnosis of congenital hypofibrinogenemia complicated by a complete placenta previa. The patient presented to labor and delivery triage with vaginal bleeding. This case report describes the management of this parturient and presents a review of the literature available for the anesthetic management of parturients with congenital hypofibrinogenemia. (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Massive Leak in CO2 Absorber of Perseus A500 Did Not Inhibit Mechanical Ventilation but Manual Bag Ventilation: A Case Report With Experimental Reproduction
Massive leaks in the anesthesia circuit may cause intraoperative hypoventilation and awareness; we experienced this with a disposable CO2 absorber in Perseus A500, which uses turbine ventilation to create positive-pressure ventilation. Consequently, manual ventilation was rendered impossible. During prolonged surgeries, CO2 absorbers may be replaced by a new one. In our case, the replacement had an occult leak. Absorbers should be checked before the exchange, and the econometer or reservoir bag’s filling state should be monitored. Anesthesia providers should know an anesthesia machine’s dynamics and breathing system to...
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Severe Acute Lung Injury After H2O2 Irrigation of an Aneurysmal Bone Cyst in an 8-Year-Old Girl: A Case Report
An 8-year-old girl developed severe acute lung injury after irrigation of a pelvic aneurysmal bone cyst with H2O2 and filling with bone cement. Sudden profound oxygen desaturation occurred on the operating table when the patient was turned from the prone to the supine position. After a brief improvement in her oxygenation, the girl developed rapidly progressing severe respiratory failure necessitating reintubation and hour-long manual ventilation, while copious amounts of hemorrhagic frothy fluids were aspirated through the endotracheal tube. The patient started to improve after 24 hours and eventually made a full recovery...
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Management of a Fragmented Angiocatheter During Central Venous Cannulation: A Case Report and Important Lessons
Complications during central venous catheter (CVC) insertion are infrequent with an incidence of 0.1%–1%. We experienced a rare CVC complication with fragmentation of the angiocatheter at its hub during central venous cannulation while utilizing the modified Seldinger technique (ie, wire through the catheter technique). Vascular surgery was emergently required to remove the catheter fragment from the neck. Clinicians must remain vigilant during all aspects of CVC insertion, including awareness of the potential for fragmentation of the angiocatheter during its removal over the in situ guidewire. Prompt recognition and app...
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
A Case Report and Anesthetic Considerations in Subcutaneous Fat Necrosis of the Newborn
Subcutaneous fat necrosis of the newborn (SCFN) is an uncommon, self-limiting panniculitis generally diagnosed in the first few weeks of extrauterine life in term or postterm infants subjected to perinatal physiologic stress. Hallmarks of the process include dramatic hypercalcemia without identifiable cause that may be associated with renal disease, seizures, and death. Herein, we describe the anesthetic approach in an 11-week-old infant, including perioperative laboratory testing, management of hypercalcemia, and intraoperative considerations. (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Ultrasonography Using the Right Supraclavicular Fossa View Detects Pathology and Facilitates Solutions for Placement of Peripherally Inserted Central Catheters: A Case Report
The right supraclavicular fossa view allows for ultrasonographic visualization of the central veins. A preprocedural scan of an asymptomatic 38-year-old man referred for peripherally inserted central catheter (PICC) insertion revealed a large thrombus in the right brachiocephalic vein. Hence, a left-sided insertion was chosen. Using the right supraclavicular view, the PICC was visualized in the left brachiocephalic vein, and the catheter was followed to its final position, avoiding contact with the thrombus. Thus, the right supraclavicular fossa view allowed for the detection of relevant pathology and facilitated an altern...
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Palliative Nerve Block for Penile Calciphylaxis: A Case Report on Ultrasound-Guided Phenol Neurolysis
A 78-year-old man with uncontrolled diabetes, heart failure, and hemodialysis-dependent end-stage renal disease presented with intractable penile pain secondary to calciphylaxis and necrosis of his glans penis. Given pain refractory to pharmacologic management and refusal of surgery, treatment entailed an ultrasound-guided dorsal penile nerve block with 5 mL of aqueous 4% phenol bilaterally. The patient reported immediate relief and died pain-free 3 months later. While phenol nerve blocks are increasingly uncommon due to local tissue toxicity, the precision of ultrasound leverages phenol’s denaturing and axonal demyelina...
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
A Case Report on Papillary Muscle Rupture Following Mitral Valve Replacement in the Setting of Previously Undiagnosed Amyloidosis
This case describes a patient who underwent mitral valve replacement (MVR) surgery with preservation of the subvalvular apparatus who suffered anterolateral papillary muscle rupture (PMR) postseparation from cardiopulmonary bypass. This patient had no history of coronary artery disease (CAD); subsequent pathology of the papillary muscle showed evidence of amyloid deposition. Although most PMRs are caused by ischemia from CAD, cardiac amyloidosis must be considered in the absence of CAD and worked up appropriately as cardiac involvement of amyloidosis, especially the amyloid light-chain (AL) subtype, is prognostic of increa...
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Hypopharyngeal Perforation Mimicking Esophageal Atresia: A Case Report of an Extremely Low Birth Weight Infant Emphasizing the Need for Preoperative Endoscopy
We report a case of an extremely low birth weight premature infant born at 27 weeks of gestation, transferred to our tertiary pediatric referral center for surgical repair of an esophageal atresia. Endoscopic evaluation before the start of surgery revealed a hypopharyngeal perforation, resulting in the false impression of esophageal atresia. If no tracheoesophageal fistula is found during tracheoscopy, esophagoscopy should be done before surgical intervention as the inability to pass a nasogastric tube into the stomach is not sufficiently reliable for a correct diagnosis of esophageal atresia. (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Potential Patent Blue V Overdose in a Patient Undergoing Free-Flap Breast Reconstruction: A Case Report
The case of a patient who experienced serious adverse effects following a potential overdose of Patent Blue V dye (PVB) is presented here. A 65-year-old woman developed cardiac arrythmias and circulatory instability 35 minutes after receiving 100 mg PVB during breast cancer surgery. An allergic reaction was assumed and treated accordingly. Intraoperatively, both epinephrine and norepinephrine infusions were required to support circulation. However, mast-cell tryptase levels were normal and subsequent allergy testing for all potential allergens was negative. This case highlights that life-threatening reactions to perioperat...
Source: A&A Case Reports - March 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
In Response
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - February 1, 2021 Category: Anesthesiology Tags: Letter to the Editor Source Type: research
Power Doppler: A Potentially Useful Technology to Assess Lobar Ventilation During Confirmation of Double-Lumen Tube
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - February 1, 2021 Category: Anesthesiology Tags: Letter to the Editor Source Type: research
In Response
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - February 1, 2021 Category: Anesthesiology Tags: Letter to the Editor Source Type: research
Retained Intracardiac Bullet Fragment: Is It a Missile Embolism or Simply a Gunshot Wound to the Heart?
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - February 1, 2021 Category: Anesthesiology Tags: Letter to the Editor Source Type: research
Design and Implementation of an Innovative, Longitudinal Wellness Curriculum in an Anesthesiology Residency Program
Burnout is a serious problem that anesthesiologists face during training and in practice. To mitigate it, experts advocate for strategies focused on enhancing individual resilience in addition to organizational change in health care systems. To catalyze this change, wellness-focused education must incorporate foundational knowledge about the science of well-being and impart skills to empower trainees to lead change in the future. We developed and implemented a longitudinal, developmental 3-year curriculum in a large anesthesiology residency program that included strategies to strengthen community-building, enhance meaning ...
Source: A&A Case Reports - February 1, 2021 Category: Anesthesiology Tags: Educational Tool Source Type: research
