Management of a Patient with a Thoracic Epidural After Accidental Clopidogrel Administration
We report a case of accidental clopidogrel administration in a patient receiving ongoing epidural analgesia postoperatively. The epidural catheter was removed 7 hours after the clopidogrel dose without incident. The onset of inhibition of adenosine diphosphate−induced platelet aggregation in healthy individuals has been reported at 12 to 24 hours after administration of a single 75-mg dose of clopidogrel. This case demonstrates the importance of understanding clopidogrel’s pharmacology to avoid ordering unnecessary tests, which may delay catheter removal. Consideration of appropriate testing and limitations in ...
Source: A&A Case Reports - July 15, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Airway Obstruction in Neonate by Velar Cyst
We describe a case of airway obstruction in a neonate by a velar cyst (a cyst located on the soft palate). We were unable to ventilate the infant’s lungs until the cyst was punctured with a syringe. (Source: A&A Case Reports)
Source: A&A Case Reports - July 15, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Experience = Education: Time for the Next Step
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - July 15, 2015 Category: Anesthesiology Tags: Editorials: Editorial Source Type: research

Perioperative Glucose Management: Point-of-Care Testing and Pseudohypoglycemia
We describe a case of pseudohypoglycemia using such testing. This case highlights the importance of individualizing perioperative glucose management to venous or arterial rather than capillary sampling in certain clinical situations. (Source: A&A Case Reports)
Source: A&A Case Reports - July 1, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Intact Survival After Obstetric Hemorrhage and 55 Minutes of Cardiopulmonary Resuscitation
We describe a successful clinical outcome after maternal cardiac arrest and 55 minutes of advanced cardiac life support. This case underscores the importance of high-quality cardiopulmonary resuscitation and raises questions about the appropriate duration of resuscitation efforts in otherwise healthy young mothers with a potentially reversible cause of arrest. (Source: A&A Case Reports)
Source: A&A Case Reports - July 1, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Management of a Parturient with Diastrophic Dysplasia
In this report, we describe our preoperative evaluation and management strategy that involved a multidisciplinary care team. (Source: A&A Case Reports)
Source: A&A Case Reports - July 1, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Hemostatic Management of Severe Thrombocytopenia in a Patient Undergoing Pulmonic Valve Replacement
We describe a case of severe thrombocytopenia refractory to platelet transfusion and hemostatic management after an urgent pulmonary valve replacement and pulmonary embolectomy. (Source: A&A Case Reports)
Source: A&A Case Reports - July 1, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

A Rare Cause of Patient Movement Occurring During Carotid Surgery
In this case, we report difficulty in the conduct of carotid surgery during an earthquake. With the epicenter>200 miles away, intraoperative movement was subtle and initially attributed to recovery from neuromuscular blockade. More significant seismic motion in a hospital is accompanied by additional challenges that are discussed. (Source: A&A Case Reports)
Source: A&A Case Reports - July 1, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Lack of Effect of Platelet Transfusions and Desmopressin on Intracranial Bleeding in a Patient Receiving Ticagrelor
We describe a case of a 67-year-old man who required emergency surgery for acute intracranial bleeding after having received a loading dose of aspirin and ticagrelor for an acute ST-elevation myocardial infarction. Before and during the craniocervical decompression, the assessment of platelet function was performed using the Multiplate® analyzer. Biological evaluation of platelet function was consistent with the clinical impression, suggesting that platelet transfusion and desmopressin administration in the presence of ticagrelor had very little, if any, hemostatic effect. (Source: A&A Case Reports)
Source: A&A Case Reports - June 15, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Cesarean Delivery in a Parturient with Left Ventricular Noncompaction Complicated by Acute Pulmonary Hypertension After Methylergonovine Administration for Postpartum Hemorrhage
We report a case of a parturient with left ventricular noncompaction causing decompensated heart failure who underwent cesarean delivery that was complicated by an acute pulmonary hypertensive crisis. (Source: A&A Case Reports)
Source: A&A Case Reports - June 15, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Presumed Group B Streptococcal Meningitis After Epidural Blood Patch
We describe a case in which a parturient received labor epidural analgesia for vaginal delivery complicated by dural puncture. The patient developed postdural puncture headache and underwent 2 separate epidural blood patch procedures. She subsequently developed a headache with fever and focal neurologic deficits. She was treated with broad spectrum antibiotics for presumed meningitis, and she made a full recovery. Blood cultures subsequently grew group B streptococcus. (Source: A&A Case Reports)
Source: A&A Case Reports - June 15, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Can the Anesthesiologist Use the Radial Artery for Monitoring After Transradial Artery Catheterization?
We present a case of an in situ access complication of transradial coronary artery catheterization. It is important for the anesthesiologist to know about the short-term and long-term consequences of this intervention, which could lead to narrowing of the artery even beyond the site of puncture. Understanding these changes could help anesthesiologists make better decisions about using the radial artery for monitoring after transradial coronary artery catheterization procedures. (Source: A&A Case Reports)
Source: A&A Case Reports - June 15, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Continuous Positive Airway Pressure with Pressure Support Ventilation Is Effective in Treating Acute-Onset Bilateral Recurrent Laryngeal Nerve Palsy
We report a case of acute VCP that was successfully treated with continuous positive airway pressure via facemask ventilation. This effective temporizing strategy allowed clinicians to plan and prepare for tracheostomy, minimizing potential complications. (Source: A&A Case Reports)
Source: A&A Case Reports - June 1, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Favorable Outcome of Rivaroxaban-Associated Intracerebral Hemorrhage Reversed by 4-Factor Prothrombin Complex Concentrate: Impact on Thrombin Generation
We report a favorable outcome in a patient receiving rivaroxaban prophylaxis, who developed a spontaneous subdural hematoma treated by a surgical evacuation and administration of 4-factor prothrombin complex concentrate. Classical coagulation variables were associated with impaired thrombin generation. Reversal with prothrombin complex concentrates improved all thrombin generation measures. Thrombin generation tests may be suitable for assessing the clinical utility of reversal drugs on rivaroxaban-induced coagulopathy. (Source: A&A Case Reports)
Source: A&A Case Reports - June 1, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Emergence Delirium with Transient Associative Agnosia and Expressive Aphasia Reversed by Flumazenil in a Pediatric Patient
We present the case of a healthy 12-year-old girl who received preoperative midazolam with the desired anxiolytic effect, underwent a brief general anesthetic, and then exhibited postoperative delirium, consisting of a transient associative agnosia and expressive aphasia. Administration of flumazenil led to immediate and lasting resolution of her symptoms. We hypothesize that γ-aminobutyric acid type A receptor-mediated effects, most likely related to an atypical offset of midazolam, are an important subset of emergence delirium that is amenable to pharmacologic therapy with flumazenil. (Source: A&A Case Reports)
Source: A&A Case Reports - June 1, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Neuraxial Anesthesia for Labor and Delivery in a Parturient with Unstable Cervical Spine Fracture
We report the successful anesthetic management of labor and passive second-stage delivery in a parturient requiring cervical spine stabilization with a halo. A 25-year-old, Gravida 1, Para 0 at 37 weeks of gestation, admitted for observation after a recent motor vehicle collision, required induction of labor for preeclampsia. The mode of delivery was dependent on a successful anesthetic technique for a passive second stage of labor. The injury and halo presented concerns for access to her airway and preservation of neurologic status. An epidural placed early in labor allowed for adequate analgesia, as well as sacral extens...
Source: A&A Case Reports - June 1, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Editorial Comment: Bloodless Orthotopic Heart Transplantation in a Jehovah’s Witness
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - May 15, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Bloodless Orthotopic Heart Transplantation in a Jehovah’s Witness
We present the case of a 53-year-old female Jehovah’s Witness with nonischemic cardiomyopathy who successfully underwent a bloodless heart transplantation using fibrinogen concentrate (RiaSTAP™; CSL Behring, King of Prussia, PA) and other blood-conservation methods. With a multidisciplinary team and the use of preoperative erythropoietin-stimulating drugs, normovolemic hemodilution, cell salvage, and pharmacotherapy to prevent and treat coagulopathy, we were able to maintain hemoglobin levels greater than 11 g/dL without the need for blood transfusion. We conclude that orthotopic heart transplants may be perfor...
Source: A&A Case Reports - May 15, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Editorial Comment: Recovery from Extreme Hemodilution (Hemoglobin Level of 0.6 g/dL) in Cadaveric Liver Transplantation and Management of a Jehovah’s Witness Patient with Sepsis and Profuse Bleeding After Emergency Coronary Artery Bypass Graft Surgery: Rethinking the Critical Threshold of Oxygen Delivery
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - May 15, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Recovery from Extreme Hemodilution (Hemoglobin Level of 0.6 g/dL) in Cadaveric Liver Transplantation
Decompensated hepatic failure occurred in a patient with a rare blood type. The patient had extreme hemodilution due to massive bleeding during liver transplantation. A shortage of matched and universal donor blood prompted us to transfuse albumin and fresh frozen plasma for intravascular volume resuscitation. The lowest hemoglobin was 0.6 g/dL, accompanied by ST depression and a serum lactate of 100 mg/dL. The accuracy of the measured value of 0.6 g/dL was confirmed. However, the patient recovered from this critical situation after transfusion, and he was eventually discharged from the hospital without significant sequela...
Source: A&A Case Reports - May 15, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Management of a Jehovah’s Witness Patient with Sepsis and Profuse Bleeding After Emergency Coronary Artery Bypass Graft Surgery: Rethinking the Critical Threshold of Oxygen Delivery
We describe a critically ill Jehovah’s Witness patient who tolerated a much lower level of DO2, coupled with severe acute anemia that persisted for>10 days without any sequelae. This case challenges the currently accepted critical DO2 threshold and highlights the need for a comprehensive approach to increase DO2 and decrease VO2 for best patient outcomes. Minimizing VO2, which is usually underemphasized in current clinical practice, probably played an important role in the survival of this patient. (Source: A&A Case Reports)
Source: A&A Case Reports - May 15, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Editorial Comment: Factor XIII: One More Critical Factor for Hemostasis
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - May 1, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Airway Compromise and Perioperative Management of a Patient with Acquired Factor XIII Inhibitor
Perioral hematomas can lead to acute airway compromise and can present significant challenges in both direct and indirect approaches to airway instrumentation. In patients with normal cell counts and routine coagulation tests, spontaneous hematomas are rare, but when encountered, they elicit a limited differential diagnosis that includes von Willebrand factor deficiency, platelet dysfunction, and the acquired factor XIII (FXIII) deficiency. Although spontaneous hematoma formation resulting from FXIII inhibition has been reported, we describe what may be the first reported case of FXIII inhibitor–related hematoma lead...
Source: A&A Case Reports - May 1, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Emergency Cardiopulmonary Bypass for Massive Pulmonary Embolism Occurring During Nephrectomy
We report a case of cardiac arrest secondary to pulmonary tumor embolization occurring in a patient undergoing nephrectomy for renal cell carcinoma with a tumor thrombus invading the inferior vena cava infrahepatically. Tumor embolization in such cases is very rare (1.5%), but if it occurs, mortality is 75%. In our case, resources were rapidly mobilized, and cardiopulmonary bypass was initiated for pulmonary embolectomy within 34 minutes of the cardiac arrest. The patient’s trachea was extubated on postoperative day 1, and he was discharged home 9 days later neurologically intact. Excellent preoperative and intraoper...
Source: A&A Case Reports - May 1, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Alcohol Increases Bonding Between the Tracheal Tube and the Tracheal Tube Connector
We report a very simple yet useful technique to circumvent this problem. (Source: A&A Case Reports)
Source: A&A Case Reports - May 1, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Contemporary Perioperative Management of Adult Familial Dysautonomia (Riley-Day Syndrome)
Familial dysautonomia (Riley-Day syndrome) is a rare multisystem disorder associated with an excess risk of perioperative morbidity and mortality. Because life expectancy is limited, few reports consider the perioperative management of familial dysautonomia in adults with advanced disease and end-organ dysfunction. Here, we report on the management of an adult patient with familial dysautonomia, highlighting recent developments in perioperative technology and pharmacology of special relevance to this challenging population. (Source: A&A Case Reports)
Source: A&A Case Reports - May 1, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Sonographically Guided Superior Laryngeal Nerve Block During Awake Fiberoptic Intubation
We report 5 patients who underwent ultrasound-guided superior laryngeal nerve block before awake intubation and general anesthesia. We used a 8- to 15-MHz hockey stick-shaped ultrasound transducer (HST15-8/20 linear probe, Ultrasonix) to visualize the superior laryngeal nerve. A 3.8-cm 25-G needle was inserted in real time and directed toward the superior laryngeal nerve followed by circumferential placement of local anesthetic. All 5 patients tolerated subsequent awake fiberoptic intubation with either minimal or no sedation. Sonographically guided superior laryngeal nerve block may be useful in patients where identificat...
Source: A&A Case Reports - April 15, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Anesthetic Management of a Parturient with Hyperekplexia
We report the case of a 38-year-old gravida 6 para 1 (G6P1) parturient with hyperekplexia who underwent successful vaginal delivery managed by the anesthesiology and neonatology service teams from initial antenatal consultation to labor and delivery to hospital discharge. (Source: A&A Case Reports)
Source: A&A Case Reports - April 15, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Venous Gas Embolism Caused by Fibrin Sealant Application to the Prostate During Greenlight Laser Photoselective Vaporization
We describe the case of a nitrogen venous gas embolism during Greenlight laser photovaporization of the prostate during the application of fibrin sealant to the operative site for hemostasis. Fibrin sealant application by a compressed gas applicator is a cause of venous air embolism, and this case highlights the need to keep venous gas embolism in mind when compressed gas applicators are used. (Source: A&A Case Reports)
Source: A&A Case Reports - April 15, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Positioning Artifact Causing Retained Foreign Object Appearance in a Radiograph of a Venous Catheter
This report is intended to raise awareness of the potential for this radiographic finding and prevent the unnecessary removal of clinically indicated CVCs. (Source: A&A Case Reports)
Source: A&A Case Reports - April 15, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Anesthesia for a Pediatric Patient with Cardiofaciocutaneous Syndrome
We describe a 6-year-old child with cardiofaciocutaneous syndrome presenting for an orthopedic procedure. He had an uneventful perioperative and postoperative course. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Massive Pulmonary Embolism in Pregnancy Treated with Catheter-Directed Tissue Plasminogen Activator
We report the use of catheter infusion thrombolysis in the successful management of a third-trimester pregnant patient with a hemodynamically significant saddle pulmonary embolus. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Paradoxical Air Embolus During Endoscopic Retrograde Cholangiopancreatography: An Uncommon Fatal Complication
Air embolism during endoscopic retrograde cholangiopancreatography is a rare but potentially fatal complication. A 66-year-old man underwent endoscopic retrograde cholangiopancreatography and remained stable until the end of the procedure, when he was found to have mottling on his right side and became hypoxic and unresponsive. Transesophageal echocardiography showed air within the left ventricle, consistent with systemic air embolism. Mortality resulted from significant cardiac and cerebral ischemia. The literature suggests that capnography is helpful in early diagnosis of air embolus, but it could not be used in this cas...
Source: A&A Case Reports - April 1, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Editorial Comment: High Frequency Ventilation and Extracorporeal Membrane Oxygenation: A Winning Combination?
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

High-Frequency Percussive Ventilation: A New Strategy for Separation from Extracorporeal Membrane Oxygenation
We report the case of a 48-year-old woman who developed severe septic shock and lung injury after community-acquired pneumonia. She was supported on arteriovenous extracorporeal membrane oxygenation (ECMO) for 19 days. To facilitate decannulation and separation from ECMO, we began trials of high-frequency percussive ventilation (HFPV) using the volumetric diffusive respiration ventilator VDR-4 (Percussionaire Corp, Sandpoint, Idaho) for 4 consecutive days (1 before and 3 after). Decannulation was achieved successfully, and the patient was transferred to the floor 3 months later. During the 4 days of HFPV, the chest radiogr...
Source: A&A Case Reports - April 1, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Superimposed Cocaine-Induced Rhabdomyolysis in a Patient with Aortic Dissection Rhabdomyolysis
A 52-year-old man presented with acute, sharp chest pain radiating to the back and abdomen after using cocaine 18 hours previously. Computed tomographic angiography revealed a type B aortic dissection that extended to the iliac arteries. The patient underwent balloon fenestration, placement of multiple aortic stents, and bilateral leg fasciotomy. He eventually went into hyperkalemic arrest but was successfully resuscitated, after which his serum lactate and creatine kinase levels peaked at 7.4 mmol/L and 990,400 U/L, respectively. The combination of aortic dissection and creatine kinase toxicity was extensive enough to cau...
Source: A&A Case Reports - March 15, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Utility of Intraoperative Lung Ultrasonography
A patient with an endobronchial tumor and critical airway obstruction developed hypoxia and hypercarbia and, subsequently, cardiac arrest during a palliative laser core-out excision. The differential diagnosis included tension pneumothorax, as well as airway obstruction due to swelling of residual tumor or to blood clots. In this case, empiric needle decompression could have had deleterious consequences. Immediate bedside lung ultrasonography provided real-time information leading to the stabilization of the patient. This case provides compelling motivation for anesthesiologists to acquire this easily learned skill. (Sourc...
Source: A&A Case Reports - March 15, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Major Pneumocephalus After Lung Resection
We present the case of a 62-year-old woman with an advanced metastatic lung tumor that required palliative debulking. Perioperative placement of a surgical clip in the dura of the thoracic spinal cord caused a dural breach, which ultimately caused a pneumocephalus. An awareness of this association is important, especially in patients undergoing thoracic resections. We also describe our approach to the management of this condition. (Source: A&A Case Reports)
Source: A&A Case Reports - March 15, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Paradoxical Hemodynamic Collapse After Subxiphoid Pericardial Window
A 56-year-old man with a history of coronary artery disease, 4 months of cough and shortness of breath, a new lung mass, and increasing hypoxemia presented to the operating room emergently for a subxiphoid pericardial window for cardiac tamponade. After 1200 mL of pericardial fluid was drained, the patient immediately went into acutely decompensated right heart failure as seen on a transesophageal echocardiogram. The patient had cardiovascular collapse refractory to high-dose vasopressors, necessitating emergent venous-arterial extracorporeal membrane oxygenation for successful resuscitation. (Source: A&A Case Reports)
Source: A&A Case Reports - March 15, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Editorial Comment: Ultrasound-Guided Peripheral Nerve Blocks for Ventricular Shunt Revision in Children: Erratum
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2015 Category: Anesthesiology Tags: Erratum: Erratum Source Type: research

Polyethylene Glycols (PEG) and Related Structures: Overlooked Allergens in the Perioperative Setting
We describe hypersensitivity to polyethylene glycols (PEGs), with cross-reactivity to a structural analog, polysorbate 80, in a 69-year-old patient with perioperative anaphylaxis and subsequent, severe anaphylactic reactions to unrelated medical products. PEGs and PEG analogs are prevalent in the perioperative setting, contained in a wide range of products seldom suspected of causing hypersensitivity reactions and thus rarely documented in surgical/anesthetic records. We suggest routine testing for PEGs after perioperative anaphylaxis because exposure to these polymers often is significant. Comprehensive brand name documen...
Source: A&A Case Reports - March 1, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Retrograde Type A Aortic Dissection After Thoracoabdominal Aneurysm Repair: Early Diagnosis with Intraoperative Transesophageal Echocardiography
Retrograde type A aortic dissection that arises immediately after open replacement of the thoracoabdominal aorta is a rare and potentially lethal complication that has only been reported twice previously. A 74-year-old man with a history of expanding Crawford type I thoracoabdominal aortic aneurysm presented for open surgical repair. The intraoperative course was unremarkable. However, intraoperative transesophageal echocardiography after the repair revealed type A aortic dissection extending up to the sinotubular junction. Subsequently, emergent aortic arch repair was performed under deep hypothermic circulatory arrest. E...
Source: A&A Case Reports - March 1, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

General Anesthesia for Adults with Mitochondrial Myopathy
We report the case of a 59-year-old woman with mitochondrial myopathy who underwent elective laparoscopic cholecystectomy and hemorrhoidectomy, and we review the literature discussing general anesthesia for adults with mitochondrial myopathy. Our management technique avoids neuromuscular-blocking drugs and uses a modified awake intubation method not previously described in such patients. We hope to improve patient safety by discussing evidence-based anesthetic concerns and complications specific to these uncommon patients and aid practitioners in devising a suitable anesthetic plan. (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Stellate Ganglion Local Anesthetic Blockade and Neurolysis for the Treatment of Refractory Ventricular Fibrillation
We report a case of ES treated safely and effectively with pharmacologic sympathectomy involving diagnostic continuous stellate ganglion blockade with local anesthetic followed by therapeutic neurolysis. This technique reduced ES in a patient for whom conservative medical and interventional procedures were ineffective. (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Anesthesia Considerations for Cesarean Delivery in a Patient with Loeys-Dietz Syndrome
A 28-year-old primigravida female with Loeys-Dietz syndrome presented at 36 weeks’ gestation for scheduled primary elective cesarean delivery. The patient had clinical findings consistent with this diagnosis, including mild aortic root dilation, chronic right vertebral artery dissection with 2 intracerebral aneurysms, and small ectasias of the thecal sac in the lumbar region. Pregnant patients with Loeys-Dietz syndrome have significant risks, including aneurysm rupture, new aneurysm formation, and uterine rupture. After a thorough preoperative evaluation, the patient underwent successful general anesthesia focused on...
Source: A&A Case Reports - February 15, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Postoperative Oxycodone Toxicity in a Patient with Chronic Pain and End-Stage Renal Disease
We present this case to review the metabolism of oxycodone and the effects of end-stage renal disease on the elimination of oxycodone and its metabolites. A 42-year-old female with end-stage renal disease who was dependent on hemodialysis presented for left hamstring posterior capsule release. She had been receiving methadone for 2 years for chronic leg pain. On postoperative day 1, the patient’s medication was changed from IV hydromorphone to oral oxycodone to treat breakthrough pain. By the next day, the patient was unarousable with notable respiratory depression. She did not fully recover after urgent hemodialysis...
Source: A&A Case Reports - February 15, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Perimortem Cesarean Delivery in a Pregnant Patient with Goiter, Preeclampsia, and Morbid Obesity
We describe a case of a successful perimortem cesarean delivery after the “4-minute rule” in a morbidly obese parturient with goiter and preeclampsia. (Source: A&A Case Reports)
Source: A&A Case Reports - February 15, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

The Use of the Molt Mouth Gag to Assist in Oral Fiberoptic Tracheal Intubation of a Developmentally Challenged Patient Presenting with Severe Trismus
We describe a case wherein the use of the Molt mouth gag significantly facilitated airway control using fiberoptic tracheal intubation. (Source: A&A Case Reports)
Source: A&A Case Reports - February 15, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Anesthetic Management of a Patient with Isovaleric Acidemia
A 3-year-old male with isovaleric acidemia presented for dental rehabilitation under general anesthesia. In times of stress, such as in the perioperative period, patients with isovaleric acidemia are at greater risk for morbidity and mortality from disordered metabolism, including glucose disturbances, hyperammonemia, hypocalcemia, and non–anion gap metabolic acidosis. Communication between the anesthesiology, dental, and endocrine teams allowed for safe and successful care of the patient. (Source: A&A Case Reports)
Source: A&A Case Reports - February 1, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Ultrasound-Guided Continuous Quadratus Lumborum Block for Postoperative Analgesia in a Pediatric Patient
In this report, we describe the use of ultrasound-guided continuous quadratus lumborum block for postoperative analgesia in a 7-year-old child scheduled to undergo radical nephrectomy (left-sided) for Wilms tumor. The result was excellent postoperative analgesia and minimal requirement for rescue analgesics. The modification described may allow easier placement of a catheter for continuous infusion of local anesthetic. (Source: A&A Case Reports)
Source: A&A Case Reports - February 1, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research