Telemedicine-Based Perioperative Management of Pheochromocytoma in a Patient With Von Hippel Lindau Disease: A Case Report
We present the case of a young woman with Von Hippel Lindau (VHL) disease who underwent a combined pheochromocytoma resection along with pancreaticoduodenectomy. Her preoperative management, including effective alpha-blockade, was conducted remotely via telemedicine video visits, patient-entered vital sign data, and secure messaging between provider and patient. Similar remote management was undertaken before a subsequent pheochromocytoma resection while the patient was pregnant, and both surgeries had positive outcomes. This represents the first time that telemedicine and mobile health monitoring have been successfully us...
Source: A&A Case Reports - January 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Stellate Ganglion Block as a Diagnostic and Therapeutic Option in Chronic Pericardial Pain: A Case Report
We describe a clinical case of a 38-year-old patient with chronic chest pain in the context of Marfan syndrome, status post–valve-sparing aortic root repair, and recurrent pericarditis. The patient suffers from chronic pericardial pain secondary to recurrent pericarditis refractory to pharmacotherapy. A left-sided stellate ganglion block (SGB) was performed for both diagnostic and therapeutic purposes. Postprocedure follow-up demonstrated significant analgesic benefit at 8 months after the procedure. (Source: A&A Case Reports)
Source: A&A Case Reports - January 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Pain Management of Scapulothoracic Fusion Using Continuous Interscalene Brachial Plexus and Erector Spinae Plane Catheters: A Case Report
We describe a patient undergoing elective scapulothoracic fusion to improve chronic pain. We demonstrated the use of 2 continuous regional catheters for perioperative analgesia to reduce opioid consumption. We used interscalene brachial plexus and erector spinae plane block with catheter insertion using continuous local anesthetic infusion. The aim was to reduce potential respiratory complications in a patient with severe restrictive lung disease and reduce hospital stay. (Source: A&A Case Reports)
Source: A&A Case Reports - January 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Case Report of Remifentanil Labor Analgesia for a Pregnant Patient With Congenital Methemoglobinemia Type 1
We present a case report of peripartum anesthetic management of a pregnant patient with congenital methemoglobinemia type 1 who received remifentanil labor analgesia and continuous methemoglobin monitoring. Continuous real-time monitoring of methemoglobin concentrations may prove to be a useful monitor in future care settings. A review of literature encompassing various perioperative and obstetric anesthesia and analgesia management considerations is presented. (Source: A&A Case Reports)
Source: A&A Case Reports - January 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Utilization of Magnesium in Opioid-Free Anesthesia for Peroral Endoscopic Myotomy: A Case Report
Optimal anesthetic management has not been studied for peroral endoscopic myotomy (POEM). This case report documents 2 patients with esophageal motility disorders who underwent POEM with opioid-free, magnesium-based anesthesia. Both patients had no postoperative esophageal complications nor need for opioid therapy. We further describe the therapeutic potential of magnesium for management of esophageal pain. (Source: A&A Case Reports)
Source: A&A Case Reports - January 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Postoperative Hyperthermia and Hemodynamic Instability in a Suspected Malignant Hyperthermia–Susceptible Patient: A Case Report
Malignant hyperthermia (MH) is a rare but potentially fatal complication of exposure to certain anesthetic drugs. However, stress-induced MH, initially observed in pigs undergoing intense physical or emotional strain, has been reported in the absence of anesthetic exposure. In this case report, we describe a case of postoperative hyperthermia and cardiac dysfunction suspicious for stress-induced MH occurring after an endobronchial biopsy in a patient with recurrent undiagnosed fevers. We also examine our diagnosis of stress-induced MH and possible preventive measures to avoid this complication. (Source: A&A Case Reports)
Source: A&A Case Reports - January 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Episodic RYR1-Related Crisis: Part of the Evolving Spectrum of RYR1-Related Myopathies and Malignant Hyperthermia-Like Illnesses
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - January 1, 2021 Category: Anesthesiology Tags: Editorial Source Type: research
In Response
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - December 1, 2020 Category: Anesthesiology Tags: Letter to the Editor Source Type: research
Multiorgan Point-of-Care Ultrasound in a Patient With Coronavirus Disease 2019 Pneumonia Complicated by Subarachnoid Hemorrhage and Pulmonary Embolism
In this report, we present a critically ill patient with severe COVID-19 pneumonia, during which he required extracorporeal membrane oxygenation and suffered from multiple complications. Bedside sonography became an important tool to manage the patient by adapting artificial ventilation parameters and played a key role in the diagnosis of thrombotic events and the monitoring of subarachnoid hemorrhage that unexpectedly complicated the case. (Source: A&A Case Reports)
Source: A&A Case Reports - December 1, 2020 Category: Anesthesiology Tags: Diagnostic Ultrasound Rounds Source Type: research
Continuous Negative Pressure Operative Field Barrier for Combined Open Tracheostomy and Percutaneous Endoscopic Gastrostomy Tube Placement During Coronavirus Disease 2019
Respiratory failure in coronavirus disease 2019 (COVID-19) patients with prolonged endotracheal intubation may require a tracheostomy and percutaneous endoscopic gastrostomy (PEG) tube placement to facilitate recovery. Both techniques are considered high-risk aerosol-generating procedures and present a heightened risk of exposure to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) for operating room personnel. We designed, simulated, and implemented a portable, continuous negative pressure, operative field barrier system using standard equipment available in hospitals to enhance health care provider safety duri...
Source: A&A Case Reports - December 1, 2020 Category: Anesthesiology Tags: Innovation Source Type: research
Retrospective Analysis of Peri-Intubation Hypoxemia During the Coronavirus Disease 2019 Epidemic Using a Protocol for Modified Airway Management
This single-center retrospective study evaluated a protocol for the intubation of patients with confirmed or suspected coronavirus disease 2019 (COVID-19). Twenty-one patients were intubated, 9 of whom were found to have COVID-19. Adherence to the airway management protocol was high. COVID-19 patients had lower peripheral capillary oxygen saturation by pulse oximetry (Spo2) nadirs during intubation (Spo2, 73% [72%–77%] vs 89% [86%–94%], P = .024), and a greater percentage experienced severe hypoxemia defined as Spo2 ≤80% (89% vs 25%, P = .008). The incidence of severe hypoxemia in COVID-19 patients should be consider...
Source: A&A Case Reports - December 1, 2020 Category: Anesthesiology Tags: Case Series Source Type: research
Right Ventricular Epicardial Pacing Postcardiac Surgery Can Cause Dynamic Right Ventricular Outflow Tract Obstruction: A Case Report
We describe 2 cases of dynamic right ventricular outflow tract obstruction that developed immediately after separation from cardiopulmonary bypass, due to temporary right ventricular epicardial pacing. Both patients had systemic hypotension which improved once ventricular pacing was discontinued. We discuss the recognition of right ventricular outflow tract obstruction as a contributing factor to hemodynamic instability, as well as the importance of identifying the underlying cause such as to institute appropriate management in these patients. (Source: A&A Case Reports)
Source: A&A Case Reports - December 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research
Two-Stage Fiberoptic Intubation in an Infant With a Rare Congenital Laryngopharyngo-Cutaneous Fistula: A Case Report
We report definitive repair of the fistula in an infant with a rare congenital laryngopharyngo-cutaneous fistula. This is the first report that describes a 2-stage fiberoptic intubation, a challenging technique performed for airway management of the aforementioned fistula in a patient with a difficult airway. (Source: A&A Case Reports)
Source: A&A Case Reports - December 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research
Scapular Block: An Innovative Procedure-Specific Regional Anesthesia Technique for Scapula Surgery—A Case Report
A 40-year-old healthy male patient underwent open reduction and internal fixation with screws and plate for a comminuted fracture of the right scapula under ultrasound-guided “scapular block” with optimal sedation. We coined the term “scapular block” for an innovative combination of previously described regional anesthesia techniques to cover all dermatomes, myotomes, and osteotomes involved in scapula surgery. It is a combination of 5 target blocks (selective superior trunk block, selective supraclavicular nerve block, subclavian perivascular block, suprascapular nerve block, and erector spinae plane block) via 3 ...
Source: A&A Case Reports - December 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research
Misinterpreting Paced Heart Rhythms: A Case Report
We describe 2 cases in which failure to properly interpret paced heart rhythms in patients with cardiac implantable electronic devices (CIEDs) undergoing surgery resulted in adverse consequences including unnecessary invasive procedures, surgical delays, and patient dissatisfaction. Both cases occurred even though experienced clinicians were involved, and all perioperative recommendations were followed. Although it is sometimes argued that anesthesiologists are not directly responsible for CIED management, they are often held accountable when problems arise. These cases reinforce the need for anesthesiologists to not only ...
Source: A&A Case Reports - December 1, 2020 Category: Anesthesiology Tags: Case Report Source Type: research
