An Untested and Uncooperative Pediatric Patient Undergoing a Dental Procedure Using a Negative Airflow Tent During the Coronavirus Disease 2019 Pandemic: A Case Report
The coronavirus disease 2019 (COVID-19) pandemic prompted the creation of novel techniques to protect patients and health care providers. Simulations showed that disposable oxygen face tents act as a physical barrier and can be repurposed as a negative airflow tent. This case study presents a pediatric patient requiring dental surgery, ineligible for preoperative testing for COVID-19 due to developmental delay and aggression. Precautionary measures were taken by means of full personal protective equipment (PPE) and negative airflow tent. The tent added additional protection and is a promising new technique that is disposab...
Source: A&A Case Reports - February 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Direct Visualization of the Dural Puncture Site During Lumbar Spine Surgery Performed Under Spinal Anesthesia: A Case Report
We present the case of a 76-year-old with progressive neurogenic claudication secondary to lumbar spinal stenosis who received SA for a 2-level lumbar posterior decompression. After decompression, the site of dural puncture from a 24-gauge Sprotte spinal needle was identified. Our intraoperative image demonstrates the submillimeter dural defect that can potentially engender complications as significant as PDPH and/or SDH. We recommend searching for, and preemptively sealing, the dural puncture site when SA is used for lumbar spine surgery. (Source: A&A Case Reports)
Source: A&A Case Reports - February 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Bloodless Management of Severe Obstetric Hemorrhage With Very Severe Anemia: A Case Report
This case report describes bloodless management of a 32-year-old Jehovah’s Witness who had severe obstetric hemorrhage at 23 weeks of gestation, spontaneously delivering twin fetuses. After resuscitation with crystalloids and colloids, the patient was still bleeding and hemoglobin fell to 3.3 g/dL. She had emergency hysterectomy. On postoperative day 1, her hemoglobin was 1.3 g/dL and Glasgow Coma Scale 6 of 15. Electrolyte derangement and fluid overload were detected and treated promptly. She regained consciousness and received intravenous iron and erythropoietin. She recovered fully without complications and without bl...
Source: A&A Case Reports - February 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Ilioinguinal/Iliohypogastric Pulsed Radiofrequency for the Treatment of Pediatric Chronic Abdominal Pain: A Case Report
We report a case highlighting the use of pulsed radiofrequency in the treatment of lower abdominal pain secondary to ilioinguinal and iliohypogastric neuralgia. In carefully selected patients, as part of a multimodal regimen, pulsed radiofrequency can aid recovery by providing effective and long-lasting pain relief, thus allowing time for effective rehabilitation. (Source: A&A Case Reports)
Source: A&A Case Reports - February 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Carotid Blood Flow–Guided Fluid Therapy in Cytoreductive Surgery With Hyperthermic Intraperitoneal Chemotherapy: A Case Report
Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is associated with significant volume shifts and requires meticulous hemodynamic management. The conventional and arbitrary “liberal” and “restrictive” fluid regimens are now being challenged. With increasing recognition of the need to individualize perioperative fluid therapy, dynamic assessment of fluid status and hemodynamic response to administration of fluids have become vital. Herein, we describe a case in which point of care ultrasound of the carotid artery and derived parameters were used to guide intraoperative fluid management. We discus...
Source: A&A Case Reports - February 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Water Accumulation in Amsorb Canister May Cause Inspiratory Flow Obstruction: A Case Report
A patient received closed-circuit anesthesia from a General Electric Avance S/5 (GE Healthcare, Madison, WI) anesthesia machine during a robotic abdominal procedure. With return of spontaneous ventilation at the end of the procedure, the negative airway pressure alarm began to sound, and a negative airway pressure of 10–15 cm H2O was observed with each breath. Replacing the CO2 absorber resolved the problem. There was considerable condensation on the walls of the Amsorb canister, and on disassembly, the sponge at the bottom was wet. Experimentation with an empty canister revealed that as little as 30 mL of water in the...
Source: A&A Case Reports - February 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Postoperative Diaphragmatic Liver Herniation Diagnosed by Point-of-Care Ultrasound
This report describes a 62-year-old women undergoing thoracoscopic right hemidiaphragm plication with acute postoperative hemodynamic instability. Bedside PoCUS identified hepatic herniation into the thorax causing cardiac compression and lateral displacement, which lead to expedited imaging and surgical reexploration. (Source: A&A Case Reports)
Source: A&A Case Reports - January 1, 2021 Category: Anesthesiology Tags: Diagnostic Ultrasound Rounds Source Type: research
Extracardiac Intrapericardial Mass Impersonating as Left Atrial Mass: Echocardiographic Perspectives
We report a case, where the preoperative TTE diagnosed an LA mass which was later confirmed to be an extracardiac intrapericardial mass by cardiac magnetic resonance imaging and intraoperative TEE. The mass was compressing the LA, and the timely diagnosis avoided the opening of the LA for mass excision. (Source: A&A Case Reports)
Source: A&A Case Reports - January 1, 2021 Category: Anesthesiology Tags: Echo Rounds Source Type: research
An Innovative Method of Delivering Nebulized Medications for Perioperative Bronchospasm
We present an innovative method for delivery of nebulized solutions, in which a jet nebulizer is paired with a Mapleson hyperinflation system. (Source: A&A Case Reports)
Source: A&A Case Reports - January 1, 2021 Category: Anesthesiology Tags: Innovation Source Type: research
Successful Use of Peripheral Nerve Blocks as the Primary Anesthetic in High-Risk Patients Undergoing Hip Surgery: A Case Series
The incidence of hip fractures in the United States is increasing as the population ages. Elderly patients are more likely to have extensive comorbidities, which contribute to long-term consequences after a hip fracture. These patients often experience permanent disability, restrictions in activities of daily life, higher rates of depression, cardiovascular disease, and mortality rate. The authors describe a combination of peripheral nerve blocks to provide surgical anesthesia for corrective hip surgery in 5 high-risk patients. (Source: A&A Case Reports)
Source: A&A Case Reports - January 1, 2021 Category: Anesthesiology Tags: Case Series Source Type: research
Perioperative Multidisciplinary Delirium Prevention: A Longitudinal Case Report
Postoperative delirium is associated with accelerated cognitive decline, mortality, and high health care costs. The importance of perioperative risk identification is increasingly recognized but optimal prevention strategies are still evolving. We review the case of an at-risk 79-year-old who had 3 lumbar spine surgeries within a year, 2 of which were complicated by postoperative delirium and one which was not. We discuss how a comprehensive preoperative cognitive assessment successfully informed perioperative decision making, including anesthetic management and postoperative multimodal delirium prevention strategies by ge...
Source: A&A Case Reports - January 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
The Anesthetic Challenges of Caring for a Pediatric Patient With Incontinentia Pigmenti: A Case Report
We present a case of an infant with IP who was brought to the operating room for panretinal diode photocoagulation under general anesthesia. The anesthesia team was unable to obtain intravenous access even with instruments such as a vein finder and ultrasound. Anesthesia for IP patients also poses challenges such as prevention of the oculocardiac reflex, obesity and airway management, and preemptive measures for intravenous access due to skin manifestations. Patients with IP may present with many challenges for the anesthesiologist during all phases of anesthetic management. (Source: A&A Case Reports)
Source: A&A Case Reports - January 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Anesthetic Management of Robotic Thymectomy in a Patient With Morvan Syndrome: A Case Report
We describe the successful administration of general anesthesia for robotic thymectomy to an MvS patient with severe encephalopathy, cardiac dysautonomia, and peripheral nerve hyperexcitation. Importantly, thymus removal provided effective source control with eventual resolution of MvS symptoms. MvS is briefly reviewed and novel observations are described of related interactions between nondepolarizing neuromuscular blockade (NDNMB) and bispectral index (BIS). (Source: A&A Case Reports)
Source: A&A Case Reports - January 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Intraoperative Diagnosis of Sodium-Glucose Cotransporter 2 Inhibitor–Associated Euglycemic Diabetic Ketoacidosis: A Case Report
We report an intraoperative diagnosis of EDKA. The patient was found to have an arterial pH of 7.21 and serum beta-hydroxybutyrate of 88.8 mg/dL (normal: (Source: A&A Case Reports)
Source: A&A Case Reports - January 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Airway Management in Complete Oral Cavity Foreign Body Obstruction: A Case Report
We present the anesthetic management of a child with complete oral cavity obstruction by a large fishing lure. (Source: A&A Case Reports)
Source: A&A Case Reports - January 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
