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

Use of Helium/Oxygen Mixture in Noninvasive Ventilation During Urgent Tracheotomy for Upper Airway Compression: A Case Report
Ventilation or oxygenation can be difficult or even impossible in cases of upper airway obstruction. In this case report, we used a helium/oxygen mixture administered via noninvasive positive-pressure ventilation to perform an urgent tracheotomy under local anesthesia on a patient presenting upper airway compression. It improved his comfort and his stridor, facilitating supine positioning. This case describes another potential indication of the helium/oxygen mixture in noninvasive ventilation. (Source: A&A Case Reports)
Source: A&A Case Reports - February 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Ultrasound-Guided Midpoint Transverse Process to Pleura Block in Breast Cancer Surgery: A Case Report
To avoid the safety issues related to thoracic paravertebral blocks, we performed midpoint transverse process to pleura blocks in 3 patients before general anesthesia for modified radical mastectomies. The midpoint transverse process to pleura blocks served as the major component of multimodal analgesia. With ultrasound guidance, 7 mL of a mixture of 0.75% ropivacaine and 2% lidocaine with epinephrine were deposited at T2, T4, and T6 levels. We noted decreased sensation to cold and pinprick from T2 to T8 dermatome level with sparing of axilla and infraclavicular areas. The maximum pain numeric rating scale score (0–1...
Source: A&A Case Reports - February 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Nutcracker Syndrome—An Unusual Case of Chronic Left Upper Abdominal Pain: A Case Report
A 38-year-old woman presented with a chief complaint of sharp, achy left upper abdominal pain with radiation to the left flank. This pain started approximately one-and-a-half years before she consulted with a pain specialist. Although an extensive workup was completed, no organic cause was established as the cause of her pain. After undergoing successful fluoroscopically guided celiac plexus blocks, an abdominal magnetic resonance imaging scan was obtained that revealed nutcracker phenomenon. The patient was evaluated by an urologist and underwent renal autotransplantation. The patient subsequently had complete relief of h...
Source: A&A Case Reports - February 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Intraoperative Generalized Tonic-Clonic Seizure and Consequent Severe Brain Bulge During Functional Motor Cortex Mapping: A Case Report
Intraoperative cortical and subcortical bipolar or monopolar mapping is the gold standard for neurosurgical procedures that involve lesions near functional or “eloquent” cortex. However, the classic Penfield stimulation has a higher intraoperative seizure rate than high-frequency short-train stimulation. As a result, high-frequency monopolar stimulation is now the most widely practiced technique. However, seizure-free mapping cannot be guaranteed even with high-frequency stimulation particularly at high current thresholds. We encountered a case of severe generalized tonic-clonic seizure and consequent severe br...
Source: A&A Case Reports - February 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Acute Adrenal Insufficiency in the Perioperative Period: A Case Report
We present the case of a 65-year-old man who, after a partial nephrectomy, developed acute adrenal insufficiency, which remained undiagnosed in the postoperative period, eventually leading to cardiac arrest. This case highlights the need for perioperative physicians to have a watchful eye for diagnosing and treating this uncommon yet lethal condition. (Source: A&A Case Reports)
Source: A&A Case Reports - February 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Twitter Hashtags for Anesthesiologists: Building Global Communities
Twitter is a social media platform that has been encouraged for use among anesthesiologists as a way to stimulate conversation, distribute research, enhance conference experiences, and expand journal club sessions. We aimed to establish the typical baseline use of hashtags that are not related to events such as conferences. Systematic searches were performed on Twitter, as well as through hashtag-tracking services, to identify actively used anesthesia-related hashtags. The most frequently used general anesthesia hashtags were #anesthesia and #anaesthesia. The most popular and relevant hashtags within anesthesia subspecialt...
Source: A&A Case Reports - January 15, 2019 Category: Anesthesiology Tags: Educational Tool Source Type: research

Postdural Puncture Headache in a Postpartum Female With Previous Spinal Surgery—Successful Treatment With Caudal Epidural Blood Patch: A Case Report
The occurrence of a postdural puncture headache (PDPH) is a known risk associated with epidural procedures. The primary nonconservative treatment option for PDPH is the performance of an epidural blood patch. This case report describes the use of image guidance for placement of a caudal epidural to treat a PDPH in a postpartum patient. A caudal catheter was placed under real-time guidance and visualization of the deposition of the blood was obtained. By entering via the caudal foramen and utilizing a catheter, manipulations in catheter placement could be performed to adjust deposition of the blood. (Source: A&A Case Reports)
Source: A&A Case Reports - January 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Novel Preoxygenation Technique to Deliver High-Flow Oxygen in a Patient With Facial Trauma: A Case Report
This study supports the use of this novel Optiflow-tracheostomy mask fusion device in appropriately selected cases. (Source: A&A Case Reports)
Source: A&A Case Reports - January 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Spinal Cord Stimulation as Treatment for Truncal Chronic Regional Pain Syndrome After Cardiac Surgery: A Case Report
A 59-year-old man presented 7 months after coronary artery bypass with continued bilateral axillary pain. His symptoms progressed over a period of months to allodynia, edema, erythema, decreased range of motion, and skin changes consistent with complex regional pain syndrome type I. After failing multiple treatment options, the patient underwent a trial of spinal cord stimulation. Leads positioned in the posterior epidural space from the seventh cervical to the third thoracic vertebral levels resulted in complete paresthesia coverage of his truncal chronic regional pain syndrome (CRPS) and the stimulation was associated wi...
Source: A&A Case Reports - January 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Electricity: How Much for the Contemporary Tertiary Care Operating Room? A Case Report
Surgery requires many electrically driven devices. Three events occurred recently in an operating room (OR) suite circa the 1980s wherein circuit breakers tripped due to overloaded circuits. This led to us to (1) increase OR electric capacity; (2) record each instrument’s power requirements, map their OR location, and determine when during surgery they were used; (3) provide users with instruction and diagrams into which outlet to plug each instrument. When introducing surgeries requiring devices, especially with high electrical power (current or amperage) demands, or renovating older or planning new ORs, it is impor...
Source: A&A Case Reports - January 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Methylnaltrexone-Associated Bowel Perforation in Postoperative Opioid-Induced Constipation and Ogilvie Syndrome: A Case Report
We report the case of an opioid-dependent 56-year-old man who underwent lumbar decompression for spinal stenosis. Postoperatively, he developed OIC and Ogilvie syndrome, then following treatment with methylnaltrexone experienced an acute bowel perforation. We briefly review the recommended management of OIC as well as indications and contraindications of methylnaltrexone and similar new medications. (Source: A&A Case Reports)
Source: A&A Case Reports - January 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

The Role of ECMO in the “At-Risk” Tracheal Extubation: A Case Report
We present the extubation of a patient with severe ankylosing spondylitis after cervical spine surgery. We discuss the use of extracorporeal membrane oxygenation (ECMO) in this “at-risk” extubation, where our ability to oxygenate was uncertain and reintubation was predicted to be difficult. To our knowledge, ECMO has not previously been used in this context. We suggest preparing ECMO for rescue oxygenation when all other fundamental oxygenation techniques are predicted to be difficult or impossible. ECMO could be included in airway management and extubation guidelines. (Source: A&A Case Reports)
Source: A&A Case Reports - January 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Transesophageal Echocardiographic Observation of Caval Thrombus Followed by Intraoperative Placement of Inferior Vena Cava Filter for Presumed Pulmonary Embolism During Cesarean Hysterectomy for Placenta Percreta: A Case Report
During a cesarean hysterectomy for placenta percreta, transesophageal echocardiography was used to monitor volume status and guide resuscitation. After delivery of the neonate but before massive surgical hemorrhage, a thrombus appeared in the inferior vena cava. Roughly 3 hours later, the patient had hemodynamic changes consistent with an intraoperative pulmonary embolism. Boluses of epinephrine stabilized the patient. An inferior vena cava filter was placed via an in situ internal jugular central venous cannula to prevent further embolic events. We believe transesophageal echocardiography is a useful monitor during surger...
Source: A&A Case Reports - January 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Ultrasonographic Diagnosis for Dysfunction of the Diaphragm After Iatrogenic Tension Pneumoperitoneum by a Gastrointestinal Endoscopic Procedure: A Case Report
We present a case of diaphragm dysfunction caused by an excessive pneumoperitoneum in a 65-year-old woman. Her abdomen became distended during endoscopic investigation and circulatory failure occurred. A computed tomography scan revealed excessive pneumoperitoneum. Urgent laparotomy was performed to repair gastric perforation. Tracheal extubation was successfully performed in the intensive care unit. After extubation, a paradoxical breathing pattern appeared in addition to tachypnea. A diagnosis of dysfunction of the bilateral diaphragm was made by ultrasonography. Although nasal high-flow cannula therapy was required for ...
Source: A&A Case Reports - January 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Real-Time Assessment of Renal Venous Flow by Transesophageal Echography During Cardiac Surgery
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - January 1, 2019 Category: Anesthesiology Tags: Echo Rounds Source Type: research

Combining Videolaryngoscopy With Fiber-Optic Orotracheal Intubation for Inclusion in the Nonemergency Pathway of the Difficult Airway Algorithm
As technology progresses, our clinical treatment options rise steadily. We are comfortable now with the handling of ready-to-use high-quality videolaryngoscopes and fiber optics, and there is increasing knowledge and practice that the combination of these 2 techniques has a high “rescue rate” in situations when fiber-optic intubation or videolaryngoscopic intubation fails. Therefore, we would recommend to specifically include this technique in the “difficult airway algorithm—nonemergency pathway,” so it comes routinely into mind when faced with a “can ventilate, but cannot intubate&rdquo...
Source: A&A Case Reports - January 1, 2019 Category: Anesthesiology Tags: Innovation Source Type: research

Unilateral Rhinorrhea and Sneezing After Upper Gastrointestinal Endoscopy Under Intravenous Propofol Sedation With Supplemental Oxygen Administered via a Nasal Cannula: A Case Report
We present a rarely described complication of unilateral rhinorrhea and sneezing in a patient who received intravenous sedation with propofol and supplemental oxygen via a nasal cannula during upper gastrointestinal endoscopy. The literature is reviewed and a mechanism is proposed. Mechanical irritation of the nasal mucosa is felt to be the trigger. Suggestions to avoid and to treat are offered. (Source: A&A Case Reports)
Source: A&A Case Reports - January 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Profound Bradycardia and Cardiac Arrest After Sugammadex Administration in a Previously Healthy Patient: A Case Report
We report the case of a 60-year-old man who underwent open radical prostatectomy for prostate adenocarcinoma. He had no known cardiac disease or symptoms other than controlled hypertension and remote history of cocaine use. The patient was given sugammadex for reversal of neuromuscular blockade and, within 1 minute, developed severe, drug-resistant bradycardia followed by pulseless electrical activity arrest. Advanced cardiac life support was initiated and continued for 15 minutes before the return of spontaneous circulation. Subsequent cardiac workup showed no abnormalities. We believe the cause of arrest was sugammadex, ...
Source: A&A Case Reports - January 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Acute Respiratory Distress in the Operating Room and Prone Ventilation: A Case Report
There have been many advances in the management of acute respiratory distress syndrome, a condition which Bellani et al, in the LUNG SAFE trial (Large Observational Study to Understand the Global Impact of Severe Acute Respiratory Failure), found represents up to 10.4% of intensive care unit admissions and 23.4% of patients requiring mechanical ventilation, with an unadjusted intensive care unit and hospital mortality of 35.3% and 40%, respectively. Studies have shown that prone positioning can improve oxygenation in patients who are mechanically ventilated for acute respiratory distress syndrome. This case report describe...
Source: A&A Case Reports - January 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Exchange Autotransfusion for Rapid Correction of Hyperkalemia During Liver Transplantation: A Case Report
A 46-year-old woman with alcoholic cirrhosis and hepatorenal syndrome requiring hemodialysis presented with hyperkalemia (5.5 mEq/L) immediately before liver transplantation. For correction of hyperkalemia, an exchange transfusion began by removing her blood into an autotransfusion system to wash out noncellular components while maintaining normovolemia. Additionally, she received washed homologous red blood cells, insulin, and glucose to minimize or reduce the degree of hyperkalemia. Serum potassium level decreased to 4.0 mEq/L within 3 hours and was 5.0 mEq/L 30 seconds after reperfusion of the grafted liver. Postreperfu...
Source: A&A Case Reports - January 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Cesarean Hysterectomy in a Parturient With Morbidly Adherent Placenta Complicated by Postoperative Ischemic Stroke Secondary to Vertebral Artery Dissection: A Case Report
We report a case of cesarean hysterectomy in a parturient with morbidly adherent placenta that was complicated by an estimated blood loss of 25 L, with the usage of massive transfusion protocols. On the third postoperative day, symptomatology suggestive of a stroke was elicited. Imaging showed a right vertebral artery dissection with cerebellar, midbrain, and pontine infarcts. She showed gradual recovery in the following months with almost complete return to baseline function. We present this case to highlight vertebral artery dissection as a potential complication after peripartum massive blood transfusion and to c...
Source: A&A Case Reports - January 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Osteopetrosis—Anesthetic Considerations for Total Knee Arthroplasty: A Case Report
We present a case report detailing our experience and discuss considerations for the care of future patients with autosomal dominant osteopetrosis. (Source: A&A Case Reports)
Source: A&A Case Reports - January 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Ultrasound Assessment of Gastric Volume After Bariatric Surgery: A Case Report
Gastric ultrasound is emerging as a tool that can be used to assess gastric content and volume in patients with an unknown fasting history. This information can impact the choice of anesthetic technique or the timing of surgery due to the presumed risk of aspiration. Currently, no data are available regarding the use of gastric ultrasound for patients who have had prior gastric operations, despite the increasing number of patients undergoing bariatric surgery. Our experience suggests that a patient with a prior Roux-en-Y gastric bypass may present with altered anatomy, rendering gastric ultrasound an ineffective technique ...
Source: A&A Case Reports - January 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Initial Evaluation for Low-Pressure Cardiac Tamponade Using Focused Cardiac Ultrasound
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - December 15, 2018 Category: Anesthesiology Tags: Echo Rounds Source Type: research

Collaborative Establishment of Difficult Vascular Access for General Anesthetic Management of an Adult With Tetra-Amelia: A Case Report
We describe the anesthetic management of a 29-year-old woman with tetra-amelia who underwent general anesthesia for tympanomastoidectomy with meatoplasty for an extensive right ear cholesteatoma. Anesthetic challenges related to tetra-amelia include difficult intravenous access, lack of sites for blood pressure monitoring, and possible difficult airway management due to craniofacial anomalies. Our case report focuses on the complex establishment of iliac artery access for invasive blood pressure monitoring by initially cannulating the carotid artery. (Source: A&A Case Reports)
Source: A&A Case Reports - December 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Anesthetic Management of a Pediatric Patient With Pelizaeus-Merzbacher Syndrome: A Case Report
A 3-year-old pediatric patient with previously diagnosed Pelizaeus-Merzbacher syndrome presented for outpatient dental restoration. Given the infrequency of this demyelinating disorder, an anesthetic plan was tailored to address the patient’s hypotonia and aspiration risk, as well as minimize potential complications including seizures, hemodynamic instability, and postoperative respiratory support. Multimodal analgesia, along with an appropriate ventilation strategy and normothermia, allowed the patient to successfully undergo a general anesthetic and be safely discharged home the same day. (Source: A&A Case Reports)
Source: A&A Case Reports - December 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research