Anesthetic Considerations in an Infant With Malan Syndrome: A Case Report
Malan syndrome, also known as Sotos-like syndrome or Sotos syndrome 2, is an overgrowth disorder that results from point mutations of the nuclear factor I/X (NFIX) gene. The phenotype consists of macrocephaly, facial dysmorphisms, hypotonia, and developmental delay. While case reports in the anesthesiology literature regarding the care of patients with Sotos syndrome do not identify significant anesthetic problems, more knowledge concerning the care of patients with Malan syndrome is necessary. Anesthesia providers must be aware of this clinical phenotype and prepare for possible difficult intravenous access and difficult ...
Source: A&A Case Reports - June 1, 2022 Category: Anesthesiology Tags: Case Report Source Type: research
Effective Treatment of Intraoperative Hiccups With Chlorpromazine Under General Anesthesia Without Muscle Relaxants: A Case Report
We report the case of a patient with vagal schwannoma who developed hiccups while under general anesthesia. Muscle relaxants were not used because the patient was under neuromonitoring. The depth of anesthesia was deepened; however, the hiccups did not disappear. The hiccups were relieved by intravenous chlorpromazine administration (total; 5 mg), which allowed for surgery under neuromonitoring. This case indicates that chlorpromazine may be effective to treat hiccups under general anesthesia. (Source: A&A Case Reports)
Source: A&A Case Reports - June 1, 2022 Category: Anesthesiology Tags: Case Report Source Type: research
Unknown Etiology for Ataxia and Vertigo After Trigeminal Nerve Block: A Case Report
We report a similar complication after the same block with nerve stimulator guidance with bupivacaine without alcohol. Stimulation of the vestibular canal by the needle, or disturbance to its blood supply, presence of an abnormal anatomical connection of the mandibular nerve and vestibular system or spasm of cerebellar arteries from the stimulating needle are possible causations rather than the drug used, whether it is alcohol or bupivacaine. Awareness of such rare but serious complications is important, and radiological-guided interventional treatment may minimize such complications. (Source: A&A Case Reports)
Source: A&A Case Reports - June 1, 2022 Category: Anesthesiology Tags: Case Report Source Type: research
Anesthetic Management of a Patient With Arterial Tortuosity Syndrome Undergoing Cerebral Revascularization Surgery—A Case Report
We present the case of a 13-year old child with arterial tortuosity syndrome who underwent occipital encephaloduroarteriomyosynangiosis for posterior circulation insufficiency. The constellation of clinical features in our patient portended significant anesthetic concerns, including difficult airway due to craniofacial abnormalities, risk of stroke, and myocardial infarction due to intracerebral and coronary arterial tortuosity and stenosis. The pertinent anesthetic implications are summarized, and we describe the anesthetic technique and use of multimodal neuromonitoring relevant for the case. (Source: A&A Case Reports)
Source: A&A Case Reports - June 1, 2022 Category: Anesthesiology Tags: Case Report Source Type: research
Combined Spinal-Epidural for Loop Ileostomy in a Patient With End-Stage Amyotrophic Lateral Sclerosis: A Case Report
Anesthesia can be a challenge for patients with amyotrophic lateral sclerosis (ALS). This progressive neurological disease is associated with a high risk of aspiration and postoperative ventilatory failure. Our patient was a 72-year-old man with ALS, quadriplegia, bulbar symptoms, dysphagia, and dysarthria who underwent palliative exploratory laparotomy and loop ileostomy creation. He received a single-shot spinal anesthetic at L4-L5 and a thoracic T11-12 epidural. He tolerated the procedure well with no perioperative pulmonary complications or worsening of his ALS. To reduce the risks of general anesthesia, we chose a neu...
Source: A&A Case Reports - May 1, 2022 Category: Anesthesiology Tags: Case Report Source Type: research
Maintaining One-Lung Ventilation With an Endobronchial Blocker Through a Damaged Left-Sided Double-Lumen Tube: A Case Report
We present a case where an EBB and a fiberoptic bronchoscope (FOB) were successfully passed through a left-sided DLT to reestablish right-lung isolation after the DLT bronchial cuff was surgically damaged. We advocate competency in placing both DLTs and EBBs, as well as having EBBs readily accessible as a secondary isolation method during OLV. (Source: A&A Case Reports)
Source: A&A Case Reports - May 1, 2022 Category: Anesthesiology Tags: Case Report Source Type: research
Anesthetic Management for Combined Anterior Cervical Spinal Decompression and Fusion and Cesarean Delivery: A Case Report
A 31-year-old G2P1 (gravida 2 para 1) woman at 34 weeks of gestation presented after a motor vehicle collision with an incomplete cervical spinal cord injury. The patient underwent emergent anterior cervical decompression and fusion (ACDF), immediately followed by cesarean delivery. We discuss the clinical decision making to perform ACDF first, weighing risks and benefits to both mother and baby. We also address important anesthetic considerations for this pregnant patient having emergent spine surgery, including positioning with left uterine displacement, rapid sequence intubation to minimize aspiration risk, choice of va...
Source: A&A Case Reports - May 1, 2022 Category: Anesthesiology Tags: Case Report Source Type: research
Dorsal Root Ganglion Stimulation to Treat Focal Postsurgical and Diffuse Chronic Pain: A Case Report
We present the case of a 46-year-old woman with severe lumbar radiculopathy with an implanted spinal cord stimulator (SCS) that had lost efficacy. She developed an incisional hernia after undergoing a minimally invasive, extreme lateral interbody fusion and SCS explant. After herniorrhaphy, she presented with severe pain at the T10-T11 dermatomes, which we treated with DRG-S. One-year after lumbar fusion, her refractory lumbar and radicular pain returned, which we ultimately treated with bilateral T12+S1 DRG-S. DRG-S was thus used to successfully treat focal postsurgical and diffuse chronic pain. (Source: A&A Case Reports)
Source: A&A Case Reports - May 1, 2022 Category: Anesthesiology Tags: Case Report Source Type: research
Posterior Reversible Encephalopathy Syndrome After Epilepsy Surgery Alerted by Low-Processed Electroencephalography Levels: A Case Report
The development of posterior reversible encephalopathy syndrome (PRES) in a patient undergoing epilepsy surgery without perioperative hypertension is uncommon. A young man having epilepsy surgery with normal blood pressures had an unexplained drop in his processed electroencephalogram (pEEG) levels intraoperatively. This alerted and prompted us to search for the cause. A postoperative electroencephalogram (EEG) confirmed a diffuse slowing of cortical waves. The intraoperative findings of pEEG, magnetic resonance imaging (MRI), and EEG postoperatively prompted a diagnosis of PRES. The patient was managed conservatively and ...
Source: A&A Case Reports - May 1, 2022 Category: Anesthesiology Tags: Case Report Source Type: research
Local Infiltration Anesthesia for Orbital Exenteration in Patients With Rhino-Orbital Cerebral Mucormycosis: A Case Series
We describe 5 patients who underwent orbital exenteration under local infiltration anesthesia with sedation. Patients and surgeons reported satisfactory conditions, with stable hemodynamics and successful day care management. Orbital exenteration under local infiltration anesthesia can be a safe and effective alternative for patients with rhino-orbital mucormycosis who are at risk with use of general anesthesia. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2022 Category: Anesthesiology Tags: Case Series Source Type: research
Intravenous Ketamine Infusion as an Adjunctive Pain Treatment for Erythromelalgia: A Pediatric Case Report
Erythromelalgia is a rare neurovascular pain condition characterized by erythematous, warm, and painful extremities. Symptoms are exacerbated by heat and relieved by cooling. Treatment is challenging and focuses on symptom control with various medications and therapies targeted toward eliminating destructive cooling behaviors. This pediatric case was notable because the patient’s pain dramatically improved after a short-term, low-dose ketamine infusion, allowing her to finally wean off detrimental cooling practices of her extremities. Intravenous ketamine has rarely been described as an adjunctive analgesic strategy for ...
Source: A&A Case Reports - April 1, 2022 Category: Anesthesiology Tags: Case Report Source Type: research
Case Report: Desmoglein-3 Gene Mutation Leading to Airway Compromise in Fraternal Twin Infants
We present two fraternal twin infants who exhibited features of airway compromise and respiratory distress shortly after birth. These infants presented with chronic, cyclical sloughing of the upper airway, larynx, and pharynx associated with difficult airway management and eventual respiratory failure. It is imperative that practitioners be aware of the severity of this rare mutation. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2022 Category: Anesthesiology Tags: Case Report Source Type: research
Central Neurogenic Hyperventilation and Hyperlactatemia After Resection of a Fourth Ventricle Tumor: A Case Report
We report a rare case of central neurogenic hyperventilation (CNH) and hyperlactatemia after resection of a fourth ventricle tumor. Our management consisted of close monitoring and exclusion of alternate causes of hyperventilation and hyperlactatemia. We hypothesize that a localized increase in tissue lactate, related to tumor metabolism, may have triggered CNH in our patient through stimulation of the brainstem respiratory centers. CNH should be considered during the differential diagnosis of perioperative hyperventilation with respiratory alkalosis in patients with posterior fossa tumors. Hyperlactatemia can trigger comp...
Source: A&A Case Reports - April 1, 2022 Category: Anesthesiology Tags: Case Report Source Type: research
Transient C5 Sensory and Motor Blockade After a Unilateral T4 Paravertebral Block: A Case Report
A thoracic paravertebral block (TPVB) can provide anesthesia for breast cancer surgeries. This case report describes a 58-year-old woman with a prolonged ipsilateral dense C5 dermatomal sensory and motor blockade after receiving a TPVB at T4 with 40 mL of 0.2% ropivacaine for a left total mastectomy, suggesting a high cephalad spread of anesthesia up to C5 paravertebral spaces. The lower extremities and the diaphragm were not involved. It is possible that the large volume of local anesthetic, even at low concentration, combined with her previous neural pathology and surgical laminectomy resulted in unexpected postoperati...
Source: A&A Case Reports - April 1, 2022 Category: Anesthesiology Tags: Case Report Source Type: research
Decreased Cerebral Perfusion Under Anesthesia During Radiation Treatment: A Case Report
We describe a case where a patient’s neck circumference increased during the course of treatment. Given that the patient was under anesthesia for each treatment, he was not able to relay the tightness of the mask. This led to cerebral hypoxia. Cerebral oximetry confirmed this diagnosis, and the patient’s mask was refitted—remaining anesthetics were uneventful. Mask fitness should be reassessed during the treatment series. (Source: A&A Case Reports)
Source: A&A Case Reports - April 1, 2022 Category: Anesthesiology Tags: Case Report Source Type: research
