Editorial Comment: Thoracic Paravertebral Blockade for the Management of Pain Associated with Cystic Fibrosis
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - February 1, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Thoracic Paravertebral Catheter Placement for Acute Rib Pain in a Pregnant Patient with Cystic Fibrosis
A 30-year-old woman with cystic fibrosis at 33 weeks, 4 days’ gestation sustained a rib injury during an acute pulmonary exacerbation, resulting in noncompliance with her chest wall oscillation therapy and worsening of her respiratory status with concern for inducing labor early. Insertion of an ultrasound-guided thoracic paravertebral catheter produced immediate pain relief, eliminating the need for further opioids, and she was able to tolerate her chest wall oscillation treatment. She was discharged home after 7 days and was able to deliver a healthy baby at 38 weeks via spontaneous vaginal delivery. (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 Thoracic Paravertebral Catheter Management of Acute Rib Pain Secondary to Cystic Fibrosis Exacerbation in a Pediatric Patient
We report the effective use of an ultrasound-guided continuous thoracic paravertebral block in the management of acute rib pain in a pediatric patient with cystic fibrosis. (Source: A&A Case Reports)
Source: A&A Case Reports - February 1, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Transient and Reproducible Loss of Motor-Evoked Potential Signals After Intravenous Levetiracetam in a Child Undergoing Craniotomy for Resection of Astrocytoma
We present a case of transient, reproducible loss of tceMEPs after an infusion of levetiracetam during craniotomy and tumor resection in a child. Cessation of the infusion resulted in restoration of baseline tceMEPs. When the infusion was resumed at the end of the procedure, a similar decrease in tceMEPs was seen as before, after the infusion was stopped. The surgery and postoperative course proceeded without incident, and the patient experienced a full recovery. (Source: A&A Case Reports)
Source: A&A Case Reports - January 15, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Acute Cellular Insulin Resistance and Hyperglycemia Associated with Hypophosphatemia After Cardiac Surgery
Successful glycemic control reduces morbidity and mortality in cardiac surgery patients. Protocols that include insulin infusions are commonly followed to achieve target blood glucose levels. Insulin resistance has been reported and linked to low serum phosphate levels in animal models and studies in diabetic outpatients, but not in postoperative patients. The following case series is a retrospective observational review of 8 cardiac surgery patients who developed insulin resistance early after surgery; this resistance was reversed by correcting serum hypophosphatemia. We discuss the multiple underlying mechanisms causing ...
Source: A&A Case Reports - January 15, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Obstetric Anesthesia for Harlequin Ichthyosis: A Unique Challenge
We report one of the only approximately 25 known current HI survivors worldwide unique in having carried a pregnancy to full term and outline challenges for the anesthesiologist during labor and delivery. (Source: A&A Case Reports)
Source: A&A Case Reports - January 15, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Anesthetic Management of Emergent Laparoscopic Bilateral Adrenalectomy in a Patient with a Life-Threatening Cortisol Crisis
We describe the anesthetic management of a patient with an ectopic adrenocorticotropic hormone-secreting tumor, whose condition was rapidly deteriorating due to severe cortisol excess, and emergent adrenalectomy was the only available therapeutic modality. Despite severe metabolic derangement, edema, and incipient respiratory failure, emergent bilateral laparoscopic adrenalectomy was performed and the patient improved sufficiently to undergo surgery for the ectopic lesion without incident. (Source: A&A Case Reports)
Source: A&A Case Reports - January 15, 2015 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Treatment of Posttraumatic Supraorbital Neuralgia Using Pulsed Radiofrequency Ablation
We present the case of a 36-year-old female patient who developed debilitating supraorbital neuralgia after a concussion and unsuccessful medical management. She underwent 2 treatments with pulsed radiofrequency ablation that resulted in significant relief, allowing her to return to work and normal daily activities. Pulsed radiofrequency ablation offers a nonsurgical option for patients with this painful disorder. (Source: A&A Case Reports)
Source: A&A Case Reports - December 15, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Awake Microlaryngoscopy and Serial Balloon Dilation in a Third Trimester Multigravida with Subglottic Tracheal Stenosis: Anesthetic Implications
We report the case of a woman in her third trimester of pregnancy, with known recurrent and worsening history of subglottic tracheal stenosis, who underwent awake microlaryngoscopy with potassium titanyl phosphate laser radial incision and serial tracheal balloon dilation under topical anesthesia with sedation. We further discuss her perioperative multidisciplinary management. (Source: A&A Case Reports)
Source: A&A Case Reports - December 15, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Conservative Treatment of an Epidural Abscess After Thoracic Epidural Catheterization
We describe a case of a thoracic epidural abscess after epidural catheter insertion in a patient undergoing lobar segmentectomy. The patient described a “pulsatile” back pain the sixth day after surgery, and purulent material at the entry site of the catheter was observed. The image of the nuclear magnetic resonance confirmed an epidural abscess that was treated conservatively with antibiotics after a consensus decision among neurosurgery, infectious diseases an anesthesia services. The abscess was reabsorbed completely with no sequelae. (Source: A&A Case Reports)
Source: A&A Case Reports - December 15, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Editorial Comment: Ultrasound-Guided Peripheral Nerve Blocks for Ventricular Shunt Revision in Children
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - December 15, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Ultrasound-Guided Peripheral Nerve Blocks for Ventricular Shunt Revision in Children
We describe using ultrasound-guided peripheral nerve blocks for postoperative pain control in 2 children undergoing ventricular shunt surgery. In the first patient undergoing ventriculo-peritoneal shunt revision, a combination of ultrasound-guided greater occipital nerve, superficial cervical plexus, and transversus abdominis plane blocks was used. In the second patient undergoing ventriculo-pleural shunt revision, a combination of ultrasound-guided greater occipital nerve, superficial cervical plexus, and intercostal blocks was used. Both patients, who underwent multiple revisions during their hospitalizations, showed dec...
Source: A&A Case Reports - December 15, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Successful Airway Management in a Patient with Severe Proximal Achalasia Requires Interdisciplinary Cooperation
We report a case of a patient undergoing esophagectomy for end-stage achalasia, a rare condition associated with potentially catastrophic ventilatory and circulatory complications. The complexity of the case necessitated preoperative planning with the surgical specialist, development of a novel algorithm for airway management, and careful implementation of our plan. Isolation of the lungs from the esophagus presented unique challenges due to not only the anatomic derangements that are the hallmark of this disease process but also an unusual anatomic finding seen in this patient. (Source: A&A Case Reports)
Source: A&A Case Reports - December 1, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Prolonged Pentobarbital-Induced Coma for the Treatment of Severe Seizures Related to Posterior Reversible Encephalopathy Syndrome
In this report, we describe a case of posterior reversible encephalopathy syndrome in a female patient after deceased donor liver transplantation. She developed posterior reversible encephalopathy syndrome on postoperative day 3 and did not improve despite adjustments in immunosuppressive therapy. The patient had symptoms of severe brain edema requiring maximal therapy, which included cooling, mannitol, 3% saline, and a pentobarbital infusion. Attempts to lighten the level of sedation failed because of recurring intractable seizure activity. Reductions in therapeutic support were ultimately successful after 62 days of cont...
Source: A&A Case Reports - December 1, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Safer Tracheostomy: A Proposal for the Routine Use of an Airway Exchange Catheter During Tracheostomy
In this report, we describe a technique to minimize the risk of airway loss by using an airway exchange catheter as an airway conduit during endotracheal tube removal. We present 2 clinical cases in which this technique was used successfully and made an important contribution to patient safety. (Source: A&A Case Reports)
Source: A&A Case Reports - December 1, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Editorial Comment: Challenges in the Perioperative Management of the Patient Receiving Extended-Release Naltrexone
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - December 1, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Challenges in the Perioperative Management of the Patient Receiving Extended-Release Naltrexone
We present a case of a 22-year-old woman receiving XR naltrexone for a history of heroin abuse undergoing a thyroidectomy and neck dissection. We discuss the intraoperative and postoperative anesthetic and analgesic planning, as well as solutions to some of the challenges these patients pose. (Source: A&A Case Reports)
Source: A&A Case Reports - December 1, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

A & A Case Reports: A Progress Report and an Update on Requirements for Patient Consent
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - December 1, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Conversion of Hemiblock to Complete Heart Block by Intraoperative Motor-Evoked Potential Monitoring
We present a case in which intraoperative monitoring with motor-evoked potentials resulted in complete heart block in a patient with a history of hemiblock. Neuromonitoring has been associated with arrhythmias in patients with ostensibly normal conduction systems, and we propose that monitoring personnel, anesthesiologists, and surgeons need to be aware of this risk and exercise caution when monitoring motor-evoked potentials in patients with known conduction deficits. (Source: A&A Case Reports)
Source: A&A Case Reports - November 15, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Editorial Comment: Misadventures with Central Venous Catheters
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - November 15, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

A Significant Complication That Occurred During Insertion of Dual Guidewires into the Right Internal Jugular Vein for Central Venous Catheterization
We report a significant complication that occurred during double guidewire insertion. The first guidewire (GW1) was inserted under ultrasonographic guidance, whereas the second guidewire (GW2) was inserted by the landmark-based method. Subsequently, GW2 penetrated and entangled with GW1, which caused difficulty in removing both guidewires. A dilator was used to dilate the puncture site, allowing simultaneous removal of both guidewires with minimal invasion. The first guidewire was found to be pointing in a cranial direction, indicating the manner in which the second guidewire’s puncture needle had penetrated it. Thus...
Source: A&A Case Reports - November 15, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Identification and Management of a Coronary Sinus Catheter Fracture
At facilities that offer cardiac surgery services, minimally invasive cardiothoracic surgery is fast becoming commonplace, particularly in aortic, tricuspid, and mitral valve procedures. Use of a coronary sinus catheter, a specialized central venous catheter, to monitor hypothermic depth and provide retrograde cardioplegia has been widely adopted at Tufts Medical Center. Complications of coronary sinus catheter insertion are considered rare but are well documented. In contrast, complications of catheter removal, such as the catheter fracture that we report here, are not well described in the literature. In this case, the c...
Source: A&A Case Reports - November 15, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Misplacement of a Pulmonary Artery Catheter
We present the case of an attempted PAC insertion in a patient undergoing implantation of a left ventricular assist device. Although physiologic pressure waveforms were established, plausible measurements of cardiac output and pulmonary capillary wedge pressure were not initially obtainable. Chest radiography showed that the catheter was looped in the pulmonary artery. This malposition could not be visualized intraoperatively by transesophageal echocardiography. The PAC was replaced in the operating room after the left ventricular assist device was implanted. (Source: A&A Case Reports)
Source: A&A Case Reports - November 15, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Dysphagia, Hoarseness, and a Hypopharyngeal Mass
We describe a patient who developed a hypopharyngeal mass (in the setting of a cervical osteophyte) while taking clopidogrel and aspirin for coronary artery disease. He had a 2-month history of progressive dysphagia and hoarseness. Physical examination and computed tomography scan revealed a soft tissue retropharyngeal mass of unclear etiology yet with a stable airway. He was admitted to the intensive care unit for a 48-hour clopidogrel washout followed by surgery. A hematoma and cervical osteophyte were removed with scant bleeding. This case report emphasizes the need to consider the medication history of a patient when a...
Source: A&A Case Reports - November 1, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Congenital Tracheal Stenosis: Unanticipated and Anticipated Difficult Airway Management in a Neonate
We present the case of a neonate with congenital tracheal stenosis (1.4-mm diameter) who came to the operating room as both an unanticipated and anticipated case of difficult airway management. We discuss the airway management of newborn children with congenital tracheal stenosis, and rescue options for the difficult airway in very small children. (Source: A&A Case Reports)
Source: A&A Case Reports - November 1, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Propionic Acidemia in a Parturient Presenting for Induction of Labor
We present a case of a parturient with propionic acidemia who presented for induction of labor. (Source: A&A Case Reports)
Source: A&A Case Reports - November 1, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Editorial Comment: Integrated Care and Teamwork: The Rashomon Effect in Cardiovascular Medicine
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - November 1, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Cardiac Tamponade After Transcatheter Aortic Valve Replacement Using a Transaortic Approach
We describe the case of a patient who presented with cardiac tamponade shortly after uneventful TAVR by a direct aortic approach. The patient was brought to the operating room for exploration and repair. Although TAVR is less invasive than traditional open aortic valve replacement, TAVR nonetheless poses serious risk. This case highlights a potential complication of the less commonly used transaortic approach for TAVR and the importance of taking a multidisciplinary approach when identifying and managing all TAVR-associated complications. (Source: A&A Case Reports)
Source: A&A Case Reports - November 1, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

In Response
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - October 15, 2014 Category: Anesthesiology Tags: Letters to the Editor: Letter to the Editor Source Type: research

Epinephrine to Reduce Local Anesthetic Systemic Toxicity in Patients Receiving TAP Blocks
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - October 15, 2014 Category: Anesthesiology Tags: Letters to the Editor: Letter to the Editor Source Type: research

Failure to Isolate the Right Lung with an EZ-Blocker
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - October 15, 2014 Category: Anesthesiology Tags: Letters to the Editor: Letter to the Editor Source Type: research

Intraoperative Diagnosis and Treatment of Thyroid Storm in a 15-Year-Old Male
Thyroid storm, a severe complication of hyperthyroidism, can be a devastating medical emergency requiring rapid management. Intraoperative thyrotoxicosis, a hypermetabolic syndrome with increased thyroid hormone levels, also presents a challenging scenario. Clinical suspicion is key along with eliminating other potentially catastrophic emergencies such as malignant hyperthermia or pheochromocytoma. In this case report, we describe a 15-year-old male undergoing halo traction placement for displaced dens and C1 fractures. Preoperative tachycardia and a history suggestive of hyperthyroidism raised our clinical suspicion for t...
Source: A&A Case Reports - October 15, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Management of Labor Analgesia in a Patient with Acute Myeloid Leukemia
We describe the anesthetic management of a laboring primigravida at 34 weeks’ gestation with new-onset acute myeloid leukemia. With multidisciplinary consultation, we recommend that neuraxial anesthesia be avoided in new-onset acute myeloid leukemia due to the risk of introducing malignant cells into the central nervous system, which can spread the disease and complicate management. We discuss the use of a fentanyl patient-controlled analgesia and dexmedetomidine as a method of labor analgesia, and the potential benefits of the latter medication in the obstetric population. (Source: A&A Case Reports)
Source: A&A Case Reports - October 15, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Facilitating Transesophageal Echocardiography Probe Placement by Esophageal Bougie in an Anesthetized Patient
The reported adverse effects of perioperative transesophageal echocardiography (TEE) are mostly associated with the insertion and manipulation of the TEE probe. Recent data suggest that blind probe insertion may be associated with greater morbidity than reported previously. Although this morbidity appears to be subclinical with unknown effects on patient outcome, evaluation of strategies for insertion is warranted. Herein, we present a novel insertion technique using a soft-tipped esophageal bougie as a guide for blind TEE probe insertion in a patient undergoing cardiac surgery. The potential advantages and related safety ...
Source: A&A Case Reports - October 15, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Editorial Comment: Intraoperative Transesophageal Echocardiography to Evaluate Acute Cessation of Venous Inflow During Cardiopulmonary Bypass
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - October 15, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Intraoperative Transesophageal Echocardiography to Evaluate Acute Cessation of Venous Inflow During Cardiopulmonary Bypass
We describe an acute obstruction of the venous cannula by blood clots that were visualized on the transesophageal echocardiogram during CPB. Appropriate measures were taken by the surgeon to evacuate the clot and restore CPB. The clots were not seen on the transesophageal echocardiogram before CPB raising suspicion that they originated in a lower extremity and migrated to the right atrium resulting in venous cannula obstruction. (Source: A&A Case Reports)
Source: A&A Case Reports - October 15, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Intracranial Violation by Nasotracheal Suction Catheter in a Patient with a History of Transsphenoidal Surgery
A 37-year-old woman underwent transsphenoidal surgery for recurrent pituitary adenoma. Postoperatively, she had a prolonged intensive care unit stay and repeated tracheal intubations because of inadequate airway reflexes. On postoperative day 25, she had difficulty maintaining her airway, and the nursing staff attempted orotracheal suctioning, which failed. Nasotracheal suctioning was then performed. Her level of consciousness declined, warranting reintubation. Computed tomography showed diffuse pneumocephalus and a new parenchymal hemorrhage. The only temporally related event was use of a nasotracheal catheter. This case ...
Source: A&A Case Reports - October 1, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Erroneous Creation of a Surgical Airway Through the Thyrohyoid Membrane
This case report illustrates the importance of proper assessment, management, and creation of an emergent surgical airway. Assessment after the establishment of surgical airways should include confirmation of correct surgical site and appropriate location and depth of tracheostomy, tracheal tube, or catheter placement within the trachea. Supraglottic surgical airway access, as occurred in this case, can lead to laryngotracheal and esophageal injury. Early recognition and appropriate management of this complication can increase the likelihood of preservation of voice and airway function and minimize the extent of esophageal...
Source: A&A Case Reports - October 1, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Anesthetic Management of a Patient with Arginase Deficiency Undergoing Liver Transplantation
A 20-year-old female underwent orthotopic liver transplantation for arginase deficiency, a urea cycle disorder. A hyperammonemic state was prevented by the administration of lipid and carbohydrate substrate and avoidance of protein loading (including human albumin) and prolonged fasting. Caval cross-clamping may have been tolerated poorly owing to the potential interaction between hyperargininemia (a nitric oxide precursor) and the lack of collateral venous drainage. Ammonia and arginine levels improved in parallel with hepatic function after reperfusion of the hepatic graft. (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Editorial Comment: Manufacturer’s Response to Thermal Burn Associated with Intraoperative Convective Forced-Air Warming Blanket (Bair Paws™ Flex Gown System)
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research

Thermal Burn Associated with Intraoperative Convective Forced-Air Warming Blanket (Bair Paws™ Flex Gown System)
We describe the likely mechanism of injury, intraoperative events suggesting special variation in the warming process, and a brief review of adverse events associated with forced-air warming systems. (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2014 Category: Anesthesiology Tags: Case Reports: Case Report Source Type: research