Bovine Hemoglobin-Based Oxygen Carrier Treatment in a Severely Anemic Jehovah’s Witness Patient After Cystoprostatectomy and Nephrectomy: A Case Report
We present the case of a 77-year-old male Jehovah’s Witness who underwent a cystoprostatectomy and radical nephrectomy with a postoperative Hb nadir of 4.5 g/dL. He received an Hb-based oxygen carrier, PEGylated carboxyhemoglobin bovine (Sanguinate), with gradual improvement in anemia symptoms and eventual discharge to a short-term rehabilitation facility. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Epidural Blood Patch for Postdural Puncture Headache due to Lumboperitoneal Shunt Placement in a Patient With Pseudotumor Cerebri: A Case Report
We present a case of a patient with pseudotumor cerebri (idiopathic intracranial hypertension) who had a lumboperitoneal shunt placed for persistent headaches and subsequently developed symptoms similar to a PDPHs that were successfully treated with an EBP. While the exact mechanism by which our patient was experiencing PDPH symptoms is unknown, the EBP administration proved to be both therapeutic and diagnostic by ruling out shunt catheter malfunction through a resolution of symptoms. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Intraoperative Cell Salvage During Transurethral Resection of Prostate: A Case Report
We describe a 71-year-old man who underwent TURP with incomplete blood cross-matching. He suffered significant hemorrhage requiring return to theater. There was great delay in obtaining appropriately cross-matched blood, due to previous alloimmunization. ICS was used to retrieve blood present in bladder irrigation. This is the first Australian report of ICS use during TURP. This case led to a change in our practice and serves to demonstrate the potential of this technology during emergencies. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Thoracic Outlet Syndrome Treated With Injecting Botulinum Toxin Into Middle Scalene Muscle and Pectoral Muscle Interfascial Planes: A Case Report
Thoracic outlet compression syndrome is a complex syndrome of neurovascular compression at the superior thoracic aperture, thought to occur at 1 of 3 anatomical compartments: the interscalene triangle, the costoclavicular space, and the retropectoralis minor space. Injection into the middle interscalene muscle (ISM) and/or pectoralis muscle plane (PECS I and II) is gaining popularity because it provides significant symptomatic relief. A 44-year-old woman was diagnosed with thoracic outlet compression syndrome, with failed conservative therapy, including physical therapy. She refused surgical intervention. ISM and PECS I an...
Source: A&A Case Reports - April 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Ultrasound-Guided Percutaneous Cryoneurolysis for Postoperative Analgesia After Limb Amputation: A Case Series
We report 3 cases in which ultrasound-guided percutaneous cryoneurolysis was performed in the perioperative period of limb amputation. All reported profound analgesia in the postoperative period without persistent postsurgical residual limb or phantom pain in the following months. No adverse events associated with the cryoneurolysis procedure occurred. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Right-to-Left Shunt During Transseptal Mitral Valve-in-Valve Replacement: A Case Report
The following case report details an 88-year-old woman with severe mitral stenosis and moderate mitral regurgitation who presented with worsening dyspnea on exertion. The patient had undergone 4-vessel coronary artery bypass graft and mitral valve replacement 14 years before and was deemed high risk for redo sternotomy. A transseptal mitral valve-in-valve replacement was performed which resulted in intraoperative hypoxia and hypotension after atrial septal defect creation for valve deployment. A right-to-left shunt had developed due to the patient’s underlying pulmonary hypertension. Successful atrial septal defect c...
Source: A&A Case Reports - April 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Hemodynamic Instability and Lipid Emulsion Resuscitation After Subcutaneous Injection of a Liposomal Bupivacaine Admixture: A Case Report
This case report describes a patient whose blood pressure decreased from a systolic pressure of 130–140 to 70–80 mm Hg after receiving extended-release liposomal bupivacaine in combination with plain bupivacaine. An 83-year-old woman with hepatocellular carcinoma presented for right hepatectomy and cholecystectomy. No hemodynamic instability was noted during the procedure. When an admixture of liposomal bupivacaine and bupivacaine hydrochloride was infiltrated into the surgical incision site during skin closure, the patient then became profoundly hypotensive. Her blood pressure was supported with phenylephrine ...
Source: A&A Case Reports - April 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Metabolic Acidosis in Postsurgical Patient on Canagliflozin and Metformin: A Case Report
Canagliflozin is a novel drug for diabetes mellitus with the mechanisms of inducing glucosuria through inhibition of the sodium-glucose cotransporter 2 in the kidney independent of insulin activity. We are reporting euglycemic ketoacidosis with severe life-threatening metabolic acidosis. The 2 patients described had type 2 diabetes mellitus and were in a state of relative starvation after abdominal surgery. The first patient had been given an oral diet but was restricted with regard to calorie and sugar intake. The second patient had been nil per os since the operation. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Iatrogenic Mitral Regurgitation After Muscular Ventricular Septal Defect Repair Detected by Transesophageal Echocardiography in a Pediatric Patient
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - March 15, 2019 Category: Anesthesiology Tags: Echo Rounds Source Type: research

Residual Obstruction After Repair of Total Anomalous Pulmonary Venous Connection: Role of Perioperative Echocardiography
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - March 15, 2019 Category: Anesthesiology Tags: Echo Rounds Source Type: research

Continuous Erector Spinae Plane and Intrathecal Opioid Analgesia: Novel Regimen Avoiding Thoracic Epidural Analgesia and Systemic Morphine in Open Radical Cystectomy: A Case Series
There has been a significant shift away from epidural analgesia after radical cystectomy within an enhanced recovery program. Alternative techniques reported including continuous erector spinae plane analgesia require supplemental systemic morphine. A new analgesic regimen is described that avoids both thoracic epidural analgesia and systemic morphine. Three adult patients undergoing open radical cystectomy, who refused thoracic epidural analgesia, were offered continuous erector spinae plane and intrathecal opioid analgesia. Median length of hospital stay was reduced by a third. The novel analgesic regimen may have the po...
Source: A&A Case Reports - March 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Noninvasive Administration of Inhaled Epoprostenol and Inhaled Milrinone in Extubated, Spontaneously Breathing Patients With Right Ventricular Failure and Portal Hypertension: A Report of 2 Cases
We describe the cases of 2 patients free from mechanical ventilation after a cardiac surgery with systemic venous congestion from right ventricular (RV) failure. Management of these patients included RV preload reduction with diuretics and RV afterload reduction with inhaled pulmonary vasodilators. Noninvasive combination of inhaled epoprostenol and inhaled milrinone through the AirLife filtered nebulizer system (CareFusion) was used. Reduction of splanchnic venous congestion was assessed by Doppler portal flow pulsatility. (Source: A&A Case Reports)
Source: A&A Case Reports - March 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Never Say Never: The Use of Nitric Oxide in Patients With Obstructed Pulmonary Veins: A Case Report
We report 3 cases with primary PVS and PH in which iNO was used to successfully decrease mean pulmonary artery pressures with clinical improvement. Based on this experience, we suggest that iNO can be used to treat PH in select patients with PVS. (Source: A&A Case Reports)
Source: A&A Case Reports - March 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Not Your Typical Dyspnea of Pregnancy: A Case Report of Transcatheter Valve-in-Valve Replacement During Pregnancy
We report a case of a transcatheter valve-in-valve implantation in the second trimester of pregnancy. The patient experienced an excellent outcome after comprehensive coordination across multiple services. We discuss anesthetic considerations in the care of the pregnant patient for transcatheter aortic valve implantation. (Source: A&A Case Reports)
Source: A&A Case Reports - March 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Inadvertent Spinal Anesthesia During Ultrasound-Guided Thoracic Paravertebral Nerve Block in a Patient With Nerve Root Sheath Cyst: A Case Report
An ultrasound-guided thoracic paravertebral nerve block was administered for left-sided abdominal pain. Lidocaine 0.4% (9.5 mL) was injected. Spinal anesthesia developed after the injection that resolved after 3 hours. One week later, a magnetic resonance imaging scan of thoracic spine identified a left T10 nerve root sheath cyst. It was postulated that the local anesthetic was injected into the cyst, which communicated with the subarachnoid space. This case report demonstrates the anatomic variations of nerve root sheath cyst sites and the risk of injection into intranerve root sheath cysts during interventional procedure...
Source: A&A Case Reports - March 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Early Massive Pulmonary Embolism After Total Hip Arthroplasty in a Patient With Behcet Disease: A Case Report
We describe a woman with BD who presented with a massive bilateral pulmonary embolism 30 hours after total hip arthroplasty. The patient underwent surgical thrombectomy and venoarterial extracorporeal membrane oxygenation. Methotrexate was withheld 15 days before surgery and restarted on postoperative day 2. Immunosuppressive therapy, such as methotrexate, appears to be the most effective prophylactic treatment for venous thrombosis in patients with BD, whereas prophylaxis with low-molecular-weight heparin may be ineffective, as was the situation in our patient. Therefore, continuation of methotrexate perioperatively shoul...
Source: A&A Case Reports - March 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Navigating Goals of Care While Confronting an Urgent, Difficult Intubation: A Case Report
In this report, we describe a case in which an airway history review revealed extraordinarily complex airway anatomy that led to a decision not to attempt intubation in a man with end-stage chronic obstructive pulmonary disease. We emphasize the utility of reviewing history and imaging before attempted urgent intubation. We discuss the importance of a multidisciplinary approach that includes the patient, their family, and consultants when high-risk intubation is contemplated. The ethical role of the anesthesiologist is also discussed. (Source: A&A Case Reports)
Source: A&A Case Reports - March 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Ultrasound-Guided, Continuous Brachial Plexus Blockade in a Neonate With Upper Extremity Limb Ischemia: A Case Report
Regional anesthetic blocks, especially in-dwelling catheters, are infrequently used in neonates and infants. The following report describes a neonate with a gangrenous right upper extremity requiring multiple painful debridements over several weeks. A brachial plexus catheter was placed using ultrasound guidance, and a continuous infusion of a local anesthetic was used to provide postoperative pain control. After the initial procedures, bolus doses of a local anesthetic agent provided surgical anesthesia for dressing changes, thus obviating the need for multiple general anesthetics. This case demonstrates the potential eff...
Source: A&A Case Reports - March 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Novel Rescue Strategy for Endotracheal Intubation Through Severe Subglottic Stenosis by Using a Metal Suction Tube as a Tube Stylet in a Neonate: A Case Report
We report a novel technique for the management of subglottic stenosis in a neonate. The initial endotracheal intubation did not provide adequate mechanical ventilation due to a significant air leak. We then performed suspension laryngoscopy and used a metal suction tube as an intubating stylet. We successfully inserted an endotracheal tube deep enough to maintain adequate mechanical ventilation. This technique is a viable rescue strategy in this clinical scenario. (Source: A&A Case Reports)
Source: A&A Case Reports - March 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Transversus Abdominis Plane Block With Ilioinguinal–Iliohypogastric Nerve a Viable Alternative to Provide Surgical Anesthesia for Cesarean Delivery: A Case Report
Acute fatty liver of pregnancy is one of the most common causes of fulminant hepatic failure. A 28-year-old G3P1L1A1 presented at 37 weeks with diagnosis of acute fatty liver of pregnancy with grade 3 hepatic encephalopathy. Laboratory findings were suggestive of coagulopathy, metabolic acidosis, and liver and renal dysfunction. Ultrasound-guided transversus abdominis plane block with ilioinguinal–iliohypogastric nerve block is widely used for postoperative analgesia. We applied these blocks, supplemented with intravenous ketamine for breakthrough visceral pain, to conduct cesarean delivery with a favorable outcome. ...
Source: A&A Case Reports - March 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Motor-Evoked Potential Monitoring: A Possible Cause of Massive Macroglossia After Posterior Cranial Fossa Surgery
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2019 Category: Anesthesiology Tags: Letter to the editor Source Type: research

Challenges in Grading Low-Flow, Low-Gradient Aortic Stenosis
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2019 Category: Anesthesiology Tags: Echo Rounds Source Type: research

Anesthesia in Patients With Multiple-System Atrophy: A Narrative Review and Practice Guidance
This article discusses multiple-system atrophy pathophysiology, clinical presentation, and perioperative issues pertinent to anesthesia. (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2019 Category: Anesthesiology Tags: Educational Tool Source Type: research

Effective Pain Management After Total Hip Arthroplasty in a Sickle Cell Patient Emphasizing Dexamethasone Sodium Phosphate/Methylprednisolone Acetate Administered via a Peripheral Nerve Blockade: A Case Report
We present a case of effective analgesia that lasted for weeks in a young opioid-tolerant female. This was achieved by the administration of glucocorticoids with different durations of action, dexamethasone sodium phosphate/methylprednisolone acetate, via a femoral/lateral femoral cutaneous nerve block placed preoperatively. Postoperatively, the patient’s opioid demand was unchanged from her preoperative baseline. She met all the discharge requirements, including physical therapy targets, on postoperative day 2 and did not have any complications during the hospitalization. (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Laparoscopic Surgery in Infants Under Spinal Anesthesia Block: A Case Report of 3 Cases
We report 3 cases of SA for inguinal hernia repairs. The contralateral inguinal region was explored by laparoscopic port placement and pneumoperitoneum through the surgical site. Ages ranged from 5 to 15 weeks, postconceptual age from 46 to 55 weeks, and weights from 4.0 to 6.6 kg. Spinal anesthetics were supplemented with intravenous dexmedetomidine. One patient experienced hypertension and tachycardia during insufflation with brief supplemental use of sevoflurane. Opioids were spared in 2 patients. Pain scores were low throughout. SA as a primary anesthetic may be used in pediatric laparoscopic procedures. (Source...
Source: A&A Case Reports - March 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Anesthetic Management of a Pediatric Patient With Bardet-Biedl Syndrome: A Case Report
In this report, we present our experience in the management of anesthesia during endoscopic sinus surgery that was performed for the first time on a 6-year-old pediatric patient diagnosed with Bardet-Biedl syndrome. (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Using the SuperNO2VA Device on a Patient With a Known Difficult Airway: A Case Report Facilitating Fiberoptic Intubation and Postoperative Nasal Positive Pressure
We present a 46-year-old man with sleep apnea and anticipated difficult airway undergoing a cardiac ablation under general endotracheal intubation. The SuperNO2VA nasal mask provided high-flow nasal oxygen and positive pressure during awake fiberoptic intubation and on extubation, maintaining airway patency in the operating room, during transport, and in recovery. The SuperNO2VA is inexpensive and portable and should be considered for high-risk patients with difficult airways. (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Complete Nephrogenic Diabetes Insipidus After Prolonged Sevoflurane Sedation: A Case Report of 3 Cases
Volatile anesthetic agents, such as sevoflurane, are increasingly used for long-term sedation in intensive care units worldwide, with improved clinical outcomes reported in recent studies due to favorable pharmacological properties. Despite possible renal toxicity related to the production of plasma inorganic fluoride and concerns related to reversible impairment of renal concentrating abilities, renal injury associated with sevoflurane sedation has rarely been reported in the intensive care unit setting. We hereby report 3 cases of nephrogenic diabetes insipidus associated with prolonged sevoflurane sedation using the Ana...
Source: A&A Case Reports - March 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Mitral Valve Compression Induced Hypoxemia After Left Ventricular Assist Device Surgery: A Case Report
Blood flow obstruction of left ventricular assist device (LVAD) is not uncommon. Causes of flow obstructions could be prepump, intrapump, and postpump. Clinical and echocardiographic parameters of LVAD obstruction vary substantially, ranging from being completely asymptomatic with unchanged functional status, normal filling pressures to frank cardiogenic shock. In the current case report, we present hypoxemia as an early presentation of LVAD inflow obstruction in the early postimplantation period in the absence of respiratory cause for hypoxemia (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Acute-Onset Quadriparesis After Placement of Thoracic Epidural: A Case Report
Blunt chest trauma and the treatment of associated pain can lead to impaired respiratory drive and abnormal pulmonary mechanics, in turn resulting in significant respiratory system complications. These can include pneumonia, hypoxia, atelectasis, and a prolonged need for invasive mechanical ventilation. Epidural analgesia can decrease the need for systemic pain control and may improve cooperation with pulmonary rehabilitation exercises. However, this treatment modality also carries a small risk of severe neurological complications such as spinal cord trauma, spinal cord ischemia, and epidural hematoma or abscess. This case...
Source: A&A Case Reports - March 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Fatal Anaphylaxis to Atracurium: A Case Report
A 52-year-old patient was scheduled for a cystoscopy. Anesthesia was induced by intravenous injection of fentanyl and propofol. After administration of atracurium, he became bradycardic and suffered a cardiac arrest. Despite prolonged cardiopulmonary resuscitation, the patient could not be revived. Electrolytes and hemoglobin levels were normal, and a transthoracic echocardiogram showed no signs of pericardial effusions or of any left ventricular contraction. The postmortem found no pathology. However, mast cell tryptase was raised significantly, indicating fatal anaphylaxis. Having presented no classic clinical signs, thi...
Source: A&A Case Reports - March 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Confirmation of Erector Spinae Plane Block Analgesia for 3 Distinct Scenarios: A Case Report
Analgesia for many open thoracic and abdominal procedures has traditionally been accomplished through neuraxial techniques or paravertebral blocks. Erector spinae plane (ESP) blocks purport effective analgesia over a similar anatomical distribution with a more favorable side effect profile and complication rate than epidurals. However, the extent of clinical applicability for ESP blocks has yet to be elucidated. In this case series, we demonstrate the efficacy of ESP blocks for 3 distinct etiologies of acute pain: planned perioperative analgesia, rescue postoperative analgesia, and traumatic pain. (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Use of Dexmedetomidine in a Parturient With Multiple Endocrine Neoplasia Type 2A Undergoing Adrenalectomy and Thyroidectomy: A Case Report
Dexmedetomidine is a selective α2-agonist, frequently used in perioperative medicine as anesthesia adjunct. The medication carries a Food and Drug Administration pregnancy category C designation and is therefore rarely used for parturients undergoing nonobstetric surgery. We are reporting the use of dexmedetomidine in the anesthetic management of a parturient undergoing minimally invasive unilateral adrenalectomy for pheochromocytoma during the second trimester of pregnancy. Additionally, because of the multiple endocrine neoplasia type 2A constellation with diagnosis of medullary thyroid cancer, the patient underwen...
Source: A&A Case Reports - March 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Guest Reviewers
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - March 1, 2019 Category: Anesthesiology Tags: Guest Reviewers Source Type: research

Proximal Isovelocity Surface Area Method for Diagnosing Isolated Pulmonary Vein Stenosis in a Case of Complete Atrioventricular Septal Defect With Increased Pulmonary Venous Blood Flow
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - February 15, 2019 Category: Anesthesiology Tags: Echo Rounds Source Type: research

Implementation of Routine Cognitive Screening in the Preoperative Assessment Clinic
We describe our preliminary experience with developing a training program and implementing routine cognitive screening in a preoperative evaluation clinic. We outline a process showing our successful clinical implementation of sustainable cognitive stratification and documentation of routine cognitive screening. (Source: A&A Case Reports)
Source: A&A Case Reports - February 15, 2019 Category: Anesthesiology Tags: Innovation Source Type: research

Cannulation of the Internal Mammary Vein With a Single-Lumen Infusion Catheter in a Patient With Portal Hypertension: A Case Report
We present a central venous catheter misplacement case. A left internal jugular vein percutaneous introducer was inserted for fluid resuscitation with a single-lumen infusion catheter placed through the lumen for medication infusions. Placement was performed under ultrasound guidance, with confirmation of the wire within the venous lumen. Radiographs suggested that the introducer had perforated the innominate vein. Contrast was injected through the single-lumen infusion catheter and showed cannulation of the left internal mammary vein. The link between portal hypertension and increased risk of central line misplacement as ...
Source: A&A Case Reports - February 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Critical Consideration of Myxedema Coma in the Postoperative Setting: A Case Report
Myxedema coma is a rare but highly fatal condition with reported mortality>40%–50%. Early recognition and prompt treatment are critical for survival. Here we describe a case of possible postoperative myxedema coma after subacute neck hematoma evacuation after hemithyroidectomy in a patient on concurrent amiodarone therapy. Symptoms included somnolence, hypothermia, and prolonged QTc with torsades de pointes resistant to magnesium therapy requiring defibrillation and overdrive pacing. Consideration of the possible diagnosis of myxedema coma resulted in prompt therapy and symptom resolution within 48 hours. Thyroid ...
Source: A&A Case Reports - February 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Pain Control in a Pediatric Patient With Sickle Cell Disease Using Regional Nerve Blocks for Laparoscopic Cholecystectomy: A Case Report
The sickle cell patient population continues to provide challenges in pain control. Current therapies include narcotic usage with adjuvant therapies such as anti-inflammatories and nonpharmacological interventions. Poor pain management in the sickle cell patient population, especially postoperatively, can lead to hypoventilation, escalating opioid requirements, poor recovery, and longer hospital stays. This case report addresses a novel addition of ultrasound-guided paravertebral and rectus sheath blocks postinduction of general anesthesia and before surgical incision to assist with the intravenous postoperative pain manag...
Source: A&A Case Reports - February 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Dexmedetomidine-Induced Massive Diuresis in a Patient Undergoing Spinal Fusion Surgery: A Case Report and Synthesis of the Literature
Dexmedetomidine is an α2-adrenergic sedative–hypnotic medication used as an adjunct to general anesthesia. While experimental studies in animals have demonstrated a mild diuretic effect of dexmedetomidine, only recently have case reports described dexmedetomidine-induced diuresis in humans. Interestingly, the majority of such cases have involved patients undergoing spinal fusion surgery. Here, we report a case of a 30-year-old woman undergoing cervical spinal fusion surgery who experienced a massive diuresis starting 30 minutes after receiving dexmedetomidine intravenous infusion. We discuss the differential di...
Source: A&A Case Reports - February 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

AMBU® LMA® in Children With Cleft Palate for Ophthalmic Surgery: A Case Report
We present the successful airway management of 2 pediatric patients with cleft palate undergoing ophthalmological surgery, using AMBU® LMA® as the airway device of choice, which was further used as a rescue airway device in an emergent situation of “difficult to ventilate.” (Source: A&A Case Reports)
Source: A&A Case Reports - February 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Placement of a Continuous Stellate Ganglion Block for Treatment of Refractory Ventricular Fibrillation in the Setting of Known Prinzmetal Angina During Pregnancy: A Case Report
A patient with a history of Prinzmetal angina, refractory ventricular fibrillation, cardiac arrest with an implantable cardioverter-defibrillator, and obesity presented to the emergency department at 17 weeks gestational age with a chief complaint of angina and multiple episodes of defibrillation. A T3/4 thoracic epidural was placed to assess the effectiveness of a partial chemical sympathectomy in alleviating symptoms of angina as well as decreasing the amount of defibrillation episodes. Once this proved to be beneficial in accomplishing both of these goals, a more specific approach was designed. A continuous stellate gan...
Source: A&A Case Reports - February 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Kratom and General Anesthesia: A Case Report and Review of the Literature
Kratom is a botanical substance derived from the Mitragyna speciosa plant, which grows naturally in Southeast Asia. Its active compounds include alkaloids with psychoactive and opioid properties. Low doses act as a stimulant, while higher doses cause analgesia and euphoria. As a drug of abuse, there are reports of seizure, acute psychosis, and death. Both the US Food and Drug Administration and the Drug Enforcement Agency warn against the use of kratom. Here is the first reported case of an anesthetic in a patient using kratom for chronic pain. (Source: A&A Case Reports)
Source: A&A Case Reports - February 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

A Misguided Contraindication: International Normalized Ratio in Acute Liver Failure Precluding Thrombolysis for Massive Pulmonary Embolism: A Case Report
We describe a patient with massive pulmonary embolism and new-onset liver failure, who—absent contraindications—warranted thrombolysis. Initial laboratory values, however, revealed an elevated international normalized ratio, which precluded lysis, despite a hypercoagulable Thromboelastogram. We believe that viscoelastic testing of coagulation is essential for evaluating coagulation in liver dysfunction, particularly when considering thrombolysis. (Source: A&A Case Reports)
Source: A&A Case Reports - February 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Rare Case of Transcutaneous Oxygen Desaturation in a Cancer Patient: A Case Report and Diagnostic Approach for a Recurrent Problem
We present a case of a 73-year-old cancer patient with low transcutaneous oxygen saturation who was transferred to the intensive care unit after deployment of the rapid response team. Differential diagnosis remained broad until methemoglobinemia (MetHb) was detected. MetHb was induced by administration of rasburicase, which was given to prevent tumor lysis syndrome. In a follow-up examination, glucose-6-phosphate dehydrogenase deficiency was found to be the cause of MetHb after rasburicase exposure. Diagnosis was made by either measuring arterial MetHb or CO oximeter. Treatment options involve transfusion and methylene b...
Source: A&A Case Reports - February 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Management of Presumed Spontaneous Intracranial Hypotension: A Case Report
We describe a case of a patient with clinical findings of spontaneous intracranial hypotension but with normal brain imaging. The patient responded to lumbar epidural blood patches and did not require additional tests to confirm the diagnosis. (Source: A&A Case Reports)
Source: A&A Case Reports - February 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Learning Preferences of First-Year Anesthesiology Residents During Their Orientation Month: A Single-Institution Study
As a step toward understanding whether learning preferences may benefit trainees and instructors, we studied the learning preferences, based on the VARK questionnaire, of anesthesiology residents during their orientation month to determine whether knowing their preferences influenced the educational resources they used. While resource utilization was similar for residents who knew their preferences and those who did not, residents overall used aural and read/write resources frequently. The learning preferences of 13 residents (72.2%) changed during the month. While further research is needed, this study provides insight in...
Source: A&A Case Reports - February 1, 2019 Category: Anesthesiology Tags: Educational Tool Source Type: research

Transesophageal Echocardiography in an Adult Patient With Double-Chambered Right Ventricle
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - February 1, 2019 Category: Anesthesiology Tags: Echo Rounds Source Type: research

Massive Hemorrhage From the Aorta on Removal of an Anterior Mediastinal Tumor in Spite of Using an Endovascular Stent Graft: A Case Report
A 68-year-old man was scheduled for mediastinal tumor resection. Aortic invasion was unclear on preoperative computed tomography. Transesophageal echocardiography showed a smooth endothelial border, but the tumor was contiguous with the distal arch, and the adventitial border was unclear. After median sternotomy, the tumor was found to be adherent to the aorta. An endovascular stent graft was placed in the distal arch to protect the aorta, but excessive bleeding occurred from the aortic defect on tumor removal. This case shows that massive hemorrhage can occur during the resection of an aorta-invading tumor despite the use...
Source: A&A Case Reports - February 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Spinal Anesthesia in 2 Consecutive Cesarean Deliveries in a Parturient With Type 3 von Willebrand Disease: A Case Report
We present the case of a woman with type 3 von Willebrand disease and a severe bleeding history that underwent successful spinal anesthesia during successive cesarean deliveries. Our case highlights the importance of early multidisciplinary consultation and advance planning in the care of these rare events. (Source: A&A Case Reports)
Source: A&A Case Reports - February 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research