In Situ Cold Perfusion of the Liver on Cardiopulmonary Bypass: Coagulopathy and Its Correction A Case Report
We report a case of profound coagulopathy after the dual insult of cold in-situ perfusion of the liver and cardiopulmonary bypass in a patient undergoing complex hepatobiliary and cardiovascular surgery. Management of this coagulopathy with conventional blood products was hindered by elevated venous pressures, thought to contribute to persistent bleeding and risked liver and right ventricular dysfunction, necessitating a change in strategy. Anesthesiologists should consider fluid-restrictive strategies to correct coagulopathy in combined liver and cardiac surgery. (Source: A&A Case Reports)
Source: A&A Case Reports - November 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

In Response
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - November 1, 2018 Category: Anesthesiology Tags: Letters to the Editor Source Type: research

Is Selective Brachial Plexus Block Necessary After Erector Spinae Plane Block in Breast Surgery?
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - November 1, 2018 Category: Anesthesiology Tags: Letters to the Editor Source Type: research

Two- and Three-Dimensional Transesophageal Echocardiographic Interrogation of an Atrial Septal Pouch Thrombosis
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - November 1, 2018 Category: Anesthesiology Tags: Echo Rounds Source Type: research

Anesthetic Management of Staged Bilateral Adrenalectomy for Neuroendocrine Tumors in a Heart-Lung Transplant Patient: A Case Report
We present the anesthetic management of a patient who was diagnosed with bilateral neuroendocrine tumors soon after heart-lung transplantation and underwent successful staged bilateral adrenalectomy. (Source: A&A Case Reports)
Source: A&A Case Reports - November 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Continuous Erector Spinae Plane Catheter for Analgesia After Infant Thoracotomy: A Case Report
We describe the placement of a continuous erector spinae plane catheter at the T5-T6 level in a 7-month-old infant who was undergoing thoracotomy for left upper lobectomy due to congenital pulmonary airway malformation. This technique resulted in outstanding analgesia without the need for opioid rescue analgesia. This block has a low degree of technical difficulty and is placed in area devoid of nearby critical structures and could be used in a number of potentially painful interventions. (Source: A&A Case Reports)
Source: A&A Case Reports - November 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Positional Oxygenation Changes in an Adult Patient With Scimitar Syndrome: A Case Report
Scimitar syndrome is a rare complex of congenital anomalies of the cardiopulmonary system. In patients with scimitar syndrome, the right pulmonary vein abnormally drains into the inferior vena cava, right atrium, coronary sinus, azygos vein, portal vein, or hepatic vein. The syndrome gets its name from the Turkish sword-like image that appears on chest x-ray. Some patients with scimitar syndrome survive in adulthood undiagnosed. Herein, we discuss positional oxygenation and hemodynamic changes associated with scimitar syndrome, especially in the left lateral decubitus position, detected during preoperative anesthetic exami...
Source: A&A Case Reports - November 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Extraforaminal Lumbar Nerve Root Stimulation for Neuropathic Pain: A Case Report
Electrical stimulation of the spinal cord is commonly used to treat neuropathic pain. However, epidural space adhesion caused by previous surgery may interfere with precise electrical lead placement. We here report a case of successful placement of electrical leads via an extraforaminal approach in the management of recurrent pain after primary spinal cord stimulation. Extraforaminal nerve root stimulation may be an alternative choice for repeated epidural spinal cord stimulation in cases of recurrent neuropathic pain. (Source: A&A Case Reports)
Source: A&A Case Reports - November 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Sinking Skin Flap Syndrome After Decompressive Craniectomy: A Case Report
Sinking skin flap syndrome is a rare complication of decompressive craniectomy characterized by a sunken skin flap, neurological deterioration, and paradoxical herniation of the brain. An absent cranium allows for external compression via atmospheric pressure, causing alterations in cerebral blood flow, cerebral spinal fluid flow, and glucose metabolism, which ultimately leads to cortical dysfunction. This case report describes a patient with relatively early onset of variable neurological symptoms and imaging correlation, leading to a diagnosis and definitive therapeutic intervention with cranioplasty. Prompt recognition ...
Source: A&A Case Reports - November 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Management Challenges in an Infant With Pentalogy of Cantrell, Giant Anterior Encephalocele, and Craniofacial Anomalies: A Case Report
Pentalogy of Cantrell is a rare syndrome consisting of midline abnormalities involving the heart, sternum, abdominal wall, and the anterior and pericardial diaphragm. This combination of defects places patients at particular perioperative risk and requires individualized management during anesthetic care. The following report documents the management of a patient with pentalogy of Cantrell, whose condition was further complicated by severe midline craniofacial abnormalities, including large anterior encephalocele, deficient mandible, tethered tongue, and cleft palate. The case offers insight into the complexity of care in ...
Source: A&A Case Reports - November 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Combined Superficial and Deep Serratus Plane Block With Bupivacaine, Dexamethasone, and Clonidine in the Treatment of a Patient With Postmastectomy Pain Syndrome: A Case Report
We present the case of a 42-year-old woman who presented to our pain clinic with a 16-month history of postmastectomy pain. We performed a combined superficial and deep serratus plane block using bupivacaine, dexamethasone, and clonidine. At 1-month follow-up, the patient had 100% pain relief. At 2-month follow-up, her pain was 5/10. The block was repeated with the same drugs at 3 months with similar pain relief. This case illustrates the utility of a combined superficial and deep serratus plane block in postmastectomy pain syndrome with a possible benefit from added dexamethasone and clonidine. (Source: A&A Case Reports)
Source: A&A Case Reports - November 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Use of an Airway Exchange Catheter-Assisted Extubation With Continuous End-Tidal Carbon Dioxide Monitoring in a Pediatric Patient With a Known Difficult Airway: A Case Report
We report a case of using an airway exchange catheter–assisted extubation with continuous end-tidal carbon dioxide monitoring for a pediatric patient with a known difficult airway. (Source: A&A Case Reports)
Source: A&A Case Reports - November 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Utility of Combined Assessment With 2- and 3-Dimensional Transesophageal Echocardiography for Acommissural Unicuspid Pulmonic Valve With Severe Pulmonic Valve Stenosis
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - October 15, 2018 Category: Anesthesiology Tags: Echo Rounds Source Type: research

Interdisciplinary Dialogue Is Needed When Defining Perioperative Recommendations: Conflicting Guidelines for Anesthetizing Patients for Pilonidal Surgery
National or international guidelines can help surgeons and anesthesiologists make treatment decisions, but the existence of conflicting recommendations can hinder treatment rather than helping. A case in point is the treatment of pilonidal sinus disease, a chronic subcutaneous infection located in the sacrococcygeal area. Its incidence is rising, reaching almost 100/100,000 inhabitants. Three surgical societies have proposed guidelines for treating the disease, but these guidelines vary greatly in their approach to anesthesia. Who should provide input into guidelines? And how can medical disciplines successfully collaborat...
Source: A&A Case Reports - October 15, 2018 Category: Anesthesiology Tags: Innovation Source Type: research

Transthoracic Arteriovenous Graft Repair With the Pectoralis (PECS) II Nerve Block for Primary Intraoperative Anesthesia and Postoperative Analgesia: A Case Report
The PECS II nerve block is a relatively new regional anesthetic technique that targets the medial and lateral pectoral nerves, as well as the lateral cutaneous branches of the intercostal nerves. It has been described for surgical cases involving the breast, as an adjunct or alternative to neuraxial or paravertebral techniques. This case report describes the first successful use of the PECS II nerve block placed using ultrasound guidance as the primary anesthetic and postoperative analgesic in a non–breast-related chest wall surgery. (Source: A&A Case Reports)
Source: A&A Case Reports - October 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Securing the Airway in Pretracheal Dermal Metastases From Oropharyngeal Carcinoma: A Case Report
We report a case of a patient with massive neck dermal metastases requiring urgent airway control for intermittent stridor. Awake tracheostomy is generally regarded as the gold standard to manage the compromised airway. However, in this unusual case, after discussion between surgeon and anesthesiologist, because of the anticipated formidable difficulties in performing awake tracheostomy, it was decided that awake fiberoptic intubation would provide the best chance of success. (Source: A&A Case Reports)
Source: A&A Case Reports - October 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Spontaneous Conversions of Supraventricular Tachycardia to Sinus Rhythm in Children After Premedication With Intranasal Dexmedetomidine: A Case Report
Intranasal dexmedetomidine administered as premedication before anesthesia and cardioversion appears to have the potential to facilitate the return of sinus rhythm. Two children, 3.5 and 1.5 years old, with recurrent supraventricular tachycardia in need of cardioversion have now on several occasions spontaneously returned to sinus rhythm within 20–40 minutes after intranasal administration of dexmedetomidine (4 μg/kg) with a mucosal atomization device. Both children were observed on all occasions at the pediatric outpatient clinic and could return home within 2 hours of cardioversion. For children with supraventri...
Source: A&A Case Reports - October 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Anesthetic Care of 2 Siblings With Neonatal Ichthyosis and Sclerosing Cholangitis Syndrome: Case Reports
We report for the first time the anesthetic management of 2 sisters suffering from neonatal ichthyosis and sclerosing cholangitis syndrome. They both presented with neonatal cholestatic jaundice and ichthyosis. The first was admitted for orthotopic liver transplantation at the age of 1 year, and the second patient underwent open pyeloplasty for a pyeloureteric junction syndrome at the age of 4 years. These 2 case reports highlight that, except for the potential difficulties with securing the catheters, dressings and endotracheal tube to the skin, the anesthetic implications of neonatal ichthyosis and sclerosing cholangitis...
Source: A&A Case Reports - October 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Percutaneous Radiofrequency Ablation of Pulmonary Metastasis and Thoracic Paravertebral Block Under Computed Tomographic Scan Guidance: A Case Report
We report the use of TPVB to relieve postprocedural pain in a 50-year-old woman after RFA of lung metastasis. The TPVB was performed under computed tomographic guidance by the anesthesiologist. The patient was pain free (rest and mobilization) during the first postoperative 36 hours. TPVB may represent an easy, safe, and effective strategy to prevent or treat postoperative pain after pulmonary RFA. (Source: A&A Case Reports)
Source: A&A Case Reports - October 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

General Anesthetic Management of a Child With Horseshoe Lung and Left Lung Hypoplasia for Cheiloplasty: A Case Report
Horseshoe lung is an extremely rare congenital malformation in which the right and left lungs are fused due to stenosis of the lung parenchyma. In anesthetic management, it is important to avoid hypoxemia and hypercapnia caused by a decline in lung capacity and functional residual capacity. A 3-year-old boy with horseshoe lung and left lung hypoplasia was scheduled to undergo cheiloplasty. Regarding respiratory management, to prevent hypoxemia and hypercapnia, we avoided intraoperative peripheral airway obstruction with positive end-expiratory pressure, set a long inspiratory phase time for sufficient alveolar expansion, a...
Source: A&A Case Reports - October 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

The Use of High-Frequency Percussive Ventilation for Whole-Lung Lavage: A Case Report
Whole-lung lavage (WLL) remains the gold standard in the treatment of pulmonary alveolar proteinosis. However, anesthetic management during WLL can be challenging because of the risk of intraoperative hypoxemia and various cardiorespiratory complications of 1-lung ventilation. Here, we describe a novel strategy involving the application of high-frequency percussive ventilation using a volumetric diffusive respirator (VDR-4) during WLL in a 47-year-old woman with pulmonary alveolar proteinosis. Our observations suggest that high-frequency percussive ventilation is a potentially effective ventilation strategy during WLL that...
Source: A&A Case Reports - October 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Intraoperative 3-Dimensional Transesophageal Echocardiography Assessment of Valvular Geometry After Implantation of Basal Annuloplasty of Cardia Externally Device for Ischemic Mitral Regurgitation
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2018 Category: Anesthesiology Tags: Echo Rounds Source Type: research

An Unusual Mechanism of Stuck Mechanical Valve Causing Severe Hemodynamic Compromise
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2018 Category: Anesthesiology Tags: Echo Rounds Source Type: research

Development of an Objective Structured Clinical Examination Using the American Board of Anesthesiology Content Outline for the Objective Structured Clinical Examination Component of the APPLIED Certification Examination
The goal of this study was to use the American Board of Anesthesiology Objective Structured Clinical Examination (OSCE) content outline as a blueprint to develop and administer a 9-station mock OSCE with station-specific checklists to senior residents (n = 14). The G- and Ф-coefficient reliability estimates were 0.76 and 0.61, respectively. Residents judged the scenarios as either extremely or somewhat realistic (88%). It is feasible to develop and administer a mock OSCE with rigorous psychometric characteristics. (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2018 Category: Anesthesiology Tags: Educational Tool Source Type: research

Radiofrequency Ablation of the Stellate Ganglion for Management of Acute Digital Ischemia: A Case Report
The authors present a report of a pulsed radiofrequency ablation of the stellate ganglion performed on a patient with microemboli to the hand from a thrombosed abandoned arteriovenous fistula. The patient was initially managed using vasodilators and anticoagulation. However, the patient’s skin mottling, pain, and decreased strength persisted. Ablation of the stellate ganglia increased perfusion to his hand and likely prevented amputation that has lasted for approximately 1 year. While radiofrequency ablation is more commonly used for pain syndromes, this is an example of its use in the treatment and potential treatme...
Source: A&A Case Reports - October 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

The Erector Spinae Plane Block Provides Complete Surgical Anesthesia in Breast Surgery: A Case Report
We described the first ultrasound-guided erector spinae plane block that provided complete surgical anesthesia for a right-sided mastectomy and axillary dissection in a patient with high cardiovascular risk. The block targeted at T5, and 20 mL of 0.5% ropivacaine with epinephrine 1:200,000 and dexamethasone 8 mg was administered. Complete anesthesia was accomplished in 20 minutes, and the patient received propofol infusion for sedation. The patient reported no pain and remained hemodynamically stable throughout the 2.5-hour procedure. At the end of the surgery, patient received morphine 2 mg and dipyrone 2 g intrave...
Source: A&A Case Reports - October 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Difficult Removal of a Nasogastric Tube Because of Knot Formation Around a Nasotracheal Tube: A Case Report
Knotting of a nasogastric (NG) tube around a left nasotracheal tube occurred in the pharynx during its blind insertion via the right nares. Unusual resistance was encountered during its advancement and attempted withdrawal. The nasotracheal tube moved in tandem with the NG tube. The NG tube was cut and the lower portion removed via the mouth and the upper portion removed via the right nares. (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Anaphylactic Reactions to Native and Light-Exposed Sugammadex Suggested by Basophil Activation Test: A Report of 2 Cases
We describe 2 patients who developed anaphylactic shock after sugammadex administration during anesthesia. Both had no history of prior sugammadex administration. The serum tryptase concentrations were elevated after the allergic reaction. Basophil activation testing 1 month after the events was positive for sugammadex in 1 patient, and negative in the other. However, it was positive for light-exposed sugammadex solution in both patients, suggesting a possible allergic reaction to a denatured compound of sugammadex generated by light exposure of the sugammadex solution. (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

When All Else Fails: Novel Use of Angiotensin II for Vasodilatory Shock A Case Report
Angiotensin (AT) II is an endogenous hormone that acts on venous and arterial smooth muscle to cause vasoconstriction. Recent trials have sparked great interest in its ability to be used as a vasopressor for catecholamine-refractory hypotension. Herein, we describe the successful use of AT II in a patient with a colonic perforation with septic shock refractory to conventional treatment. After AT II initiation, there was an immediate reduction in catecholamine requirement, and the patient survived. (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Lidocaine Patch to Treat Postoperative Tourniquet Pain After Total Knee Replacement: A Case Report
We present a patient who underwent a total knee arthroplasty under general anesthesia and an adductor canal nerve block. She complained of intractable thigh pain postoperatively. Lidocaine 5% patches completely resolved her postoperative tourniquet-related pain. (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Type B Aortic Dissection Diagnosed by Left-Sided Transthoracic Ultrasonography in a Woman With Preeclampsia
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - September 15, 2018 Category: Anesthesiology Tags: Echo Rounds Source Type: research

Awake Fiberoptic Intubation in Fast Track Ambulatory Surgery: A Case Report
We present 3 cases scheduled for day-case procedures with predicted difficult airways, where the feasibility of awake fiberoptic intubation is demonstrated in a Scandinavian fast track setting. Our hypothesis is that, with accurate preparations, intubation times are comparable with conventional intubation and that the procedure is associated with only minor patient discomfort. (Source: A&A Case Reports)
Source: A&A Case Reports - September 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Laryngoscopy and Bronchoscopy in an Infant With a Congenital Laryngeal Web Complicated by Bilateral Pneumothoraces: A Case Report
We present a 2-day-old neonate with aphonia and stridor who underwent microdirect laryngoscopy. Intraoperatively, a Cohen type 4 laryngeal web was diagnosed not immediately amenable to resection. Therefore, the decision was made for endotracheal intubation and subsequent tracheostomy. After endotracheal intubation, there was acute respiratory compromise and oxygen desaturation that improved moderately after urgent tracheostomy. A chest radiograph revealed a large pneumothorax. Our experience suggests that in the presence of high-grade laryngeal webs, the possibility of intraoperative development of pneumothorax should be c...
Source: A&A Case Reports - September 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Central Sleep Apnea Post Vagal Nerve Manipulation and Stimulation During Neck Tumor Resection: A Case Report
We describe a pediatric patient who underwent neck dissection for removal of a tumor and had unexpected transient central sleep apnea in the recovery room. To the best of our knowledge, this is the first report in the existing literature of central sleep apnea after surgical manipulation of the vagal nerve under anesthesia. (Source: A&A Case Reports)
Source: A&A Case Reports - September 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Spinal Cord Neuromodulation Therapy for Levofloxacin-Reinduced Complex Regional Pain Syndrome and Neurotoxicity: A Case Report
We present here a case of a 43-year-old woman with previously resolved type I complex regional pain syndrome (CRPS) who presented with symptoms of CRPS and neurotoxicity in the setting of levofloxacin administration. Our aim is to advocate for increased caution in prescribing to patients with a history of neuropathology including CRPS. (Source: A&A Case Reports)
Source: A&A Case Reports - September 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Allergic Acute Coronary Syndrome (Kounis Syndrome) in a Young Woman During Spinal Anesthesia: A Case Report
We present a case of a young woman who experienced attacks of dyspnea, hypoxemia, and hypotension during and after spinal anesthesia. Based on the pattern of clinical symptoms and laboratory findings, she was retrospectively diagnosed with Kounis syndrome, even though no apparent trigger of hypersensitivity was found. (Source: A&A Case Reports)
Source: A&A Case Reports - September 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Parturient With Barnes Syndrome (Thoracolaryngopelvic Dysplasia) Undergoing Cesarean Delivery of a Neonate With Barnes Syndrome: A Case Report
This case describes a parturient with Barnes syndrome, a rare disorder characterized by subglottic stenosis, thoracic dystrophy, and small pelvic inlet, who underwent cesarean delivery of a neonate diagnosed with Barnes syndrome. Live simulation training was performed by multidisciplinary team to prepare for the spinal anesthetic, personnel flow between 2 operating rooms, and management of various airway scenarios for the newborn. After delivery, the neonate underwent laryngoscopy–bronchoscopy with successful intubation in the operating room because of labored breathing. Airway evaluation revealed subglottic stenosis...
Source: A&A Case Reports - September 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

It Is Not Always the Epidural: A Case Report of Anterior Spinal Artery Ischemia in a Trauma Patient
This report describes a trauma patient who developed hypotension and lower extremity weakness after epidural placement for multiple rib fractures. Initially, hypotension was attributed to neuraxial sympathectomy. However, physical examination also indicated anterior spinal artery ischemia. Regional anesthesia and acute pain teams must be able to both identify contraindications and complications of regional techniques and discern when complications are not a result of regional interventions to initiate prompt management and definitive care. (Source: A&A Case Reports)
Source: A&A Case Reports - September 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Continuous Pectoral Fascia Blocks for Postoperative Analgesia After Median Sternotomy: A Case Report
We report a novel case of a patient who presented for aortic valve replacement via median sternotomy. Bilateral continuous pectoral fascia blocks were placed to provide postoperative analgesia. Both numerical rating scale pain scores and opioid consumption after surgery were suggestive of analgesic benefit. (Source: A&A Case Reports)
Source: A&A Case Reports - September 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

It’s All in the Name: Anesthesiologist Versus Physician Anesthesiologist
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - September 1, 2018 Category: Anesthesiology Tags: Letter to the Editor Source Type: research

Aortic Dissection: True or False?
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - September 1, 2018 Category: Anesthesiology Tags: Echo Didactics Source Type: research

Management of a Patient With a History of Nonanesthesia-Related Malignant Hyperthermia Undergoing Laparoscopic Cholecystectomy: A Case Report
A 36-year-old African American with a medical history of nonanesthesia-related malignant hyperthermia (MH) who was taking chronic oral dantrolene therapy presented with right upper quadrant pain for a laparoscopic cholecystectomy. A multidisciplinary perioperative plan was implemented with the goal of avoiding triggering an MH episode or rhabdomyolysis. He developed a postoperative left brachial vein thrombus of unclear etiology, possibly related to dantrolene administration or his underlying susceptibility to MH. (Source: A&A Case Reports)
Source: A&A Case Reports - September 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Anterior Cutaneous Nerve Entrapment Syndrome in a Pediatric Patient Previously Diagnosed With Functional Abdominal Pain: A Case Report
Chronic abdominal pain is common in children and adolescents but challenging to diagnose, because practitioners may be concerned about missing serious occult disease. Abdominal wall pain is an often ignored etiology for chronic abdominal pain. Anterior cutaneous nerve entrapment syndrome causes abdominal wall pain but is frequently overlooked. Correctly diagnosing patients with anterior cutaneous nerve entrapment syndrome is important because nerve block interventions are highly successful in the remittance of pain. Here, we present the case of a pediatric patient who received a diagnosis of functional abdominal pain but e...
Source: A&A Case Reports - September 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Treatment of Transradial Angiogram Catheter Entrapment by Axillary Artery Spasm With Supraclavicular Brachial Plexus Block: A Case Report
We present a 36-year-old female patient who underwent transradial cerebrovascular angiography because of acute putaminal hemorrhage. Catheter entrapment occurred with severe pain in the right upper arm proximal to the elbow. A subclavian artery angiogram by way of a transfemoral crossover catheter revealed severe vasospasm in the axillary artery distal to the branch point between it and the posterior brachial circumflex artery. Diazepam 5 mg intravenously (IV) through a peripheral catheter, lidocaine 0.5% 5 mL injected subcutaneously, and lidocaine 2% 4 mL IV isosorbide dinitrate 2 mg IV through the angiograp...
Source: A&A Case Reports - September 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Focused Cardiac Ultrasound Determines Cause of Cardiovascular Collapse During Thoracic Surgery in a Patient With Undiagnosed Pulmonary Hypertension: A Case Report
We present a patient with previously undiagnosed PHT who suffered 2 cardiac arrests during emergent thoracic surgery for empyema. After successful resuscitation in the operating room, she subsequently required prolonged venoarterial extracorporeal membrane oxygenation. Focused transthoracic echocardiography to evaluate cardiac function was critical in the diagnosis of PHT and subsequent treatment with sildenafil and nifedipine when discharged from the hospital. (Source: A&A Case Reports)
Source: A&A Case Reports - September 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Oropharyngeal Stenosis Leading to an Unanticipated Difficult Airway in a Patient After Uvulopalatopharyngoplasty: A Case Report and Review of the Literature
We report the case of an asymptomatic adult woman found to have oropharyngeal stenosis after induction of anesthesia and discuss the management of this challenging scenario. We also contrast oropharyngeal stenosis with nasopharyngeal stenosis, another rare complication of uvulopalatopharyngoplasty. (Source: A&A Case Reports)
Source: A&A Case Reports - September 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Safe Use of Epidural Analgesia in a Parturient With Spinocerebellar Ataxia: A Case Report
A 28-year-old, gravida 7, para 4 woman with medical history of sickle cell trait presented to labor and delivery at 39 weeks of gestation for rupture of membranes. The patient had a history of suspected spinocerebellar ataxia with incomplete workup before the current admission. The patient requested epidural analgesia for labor. Epidural was placed at L3–L4 interspace without any complications and the rest of the labor was uneventful. Magnetic resonance imaging of the brain was performed after the delivery and the diagnosis of spinocerebellar ataxia was confirmed. The patient’s neurological status remained stab...
Source: A&A Case Reports - September 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Two-Level Continuous Thoracic Paravertebral Nerve Blocks Providing Opioid-Free Postoperative Analgesia After Latissimus Dorsi Flap Breast Reconstruction: A Case Report
We report that multilevel paravertebral nerve blockade could represent an opioid-sparing alternative for postoperative analgesia for latissimus dorsi flap breast reconstruction patients. (Source: A&A Case Reports)
Source: A&A Case Reports - September 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Intraoperative Venovenous Extracorporeal Membrane Oxygenation as Rescue for a Patient With an Inhalational Burn and Iatrogenic Upper Airway Injury: A Case Report
Venovenous extracorporeal membrane oxygenation (VV-ECMO) is a well-established alternative oxygenation method for critically ill patients. A 58-year-old male was transferred to our level 1 trauma and burn center after sustaining an inhalational injury from a carburetor explosion, with subsequent iatrogenic tracheal injury and emergent cricothyrotomy before arrival. During attempted surgical airway stabilization, our ability to ventilate and oxygenate was compromised. Intraoperative VV-ECMO enabled rescue from severe hypoxemia and subsequent recovery without lasting neurologic sequelae. This case highlights the utility of V...
Source: A&A Case Reports - September 1, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research

Postoperative Airway Obstruction in a Low Resource Setting: A Case Report
A 2-month-old girl with abnormal facial features and malnutrition presented for placement of a gastrostomy tube. The surgery was performed under general anesthesia using a laryngeal mask airway (LMA); however, after removal of the LMA, the patient had recurrent airway collapse, requiring repeated insertion of the LMA. The authors describe the management of this problem with the use of a tongue suture and anterior traction in the postoperative period in a resource-limited setting. (Source: A&A Case Reports)
Source: A&A Case Reports - August 15, 2018 Category: Anesthesiology Tags: Case Reports Source Type: research