A Commendable and Sensible but Not Novel Approach
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - November 15, 2019 Category: Anesthesiology Tags: Letters to the Editor Source Type: research

OxyTain Cannot Intubate, Cannot Oxygenate Algorithm
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - November 15, 2019 Category: Anesthesiology Tags: Letters to the Editor Source Type: research

Standing on the Shoulders of Giants: OxyTain Is an Evolution of the Heard Cannot Intubate, Cannot Ventilate Algorithm
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - November 15, 2019 Category: Anesthesiology Tags: Letters to the Editor Source Type: research

OxyTain: Not Unique, But a Successful Adaptation of the Royal Perth Hospital “Cannot Intubate, Cannot Oxygenate” Rescue Approach in a North American Setting
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - November 15, 2019 Category: Anesthesiology Tags: Letters to the Editor Source Type: research

Epicardial Echocardiography as Rescue Modality for Detection of Dynamic Right Ventricular Outflow Tract Obstruction in Post Pulmonary Valve Stenosis Repair
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - November 15, 2019 Category: Anesthesiology Tags: Echo Rounds Source Type: research

Undiagnosed Systemic Mastocytosis Presenting as Postoperative Distributive Shock: A Case Report
We present a case of a 69-year-old male with abrupt and recurrent episodes of anaphylaxis with refractory distributive shock following cardiac surgery with cardiopulmonary bypass. Following a complex postoperative course, a bone marrow biopsy ultimately confirmed the diagnosis. Although rare, SM should be considered in the differential diagnosis of postoperative patients with unexplained and recurrent episodes of distributive shock. (Source: A&A Case Reports)
Source: A&A Case Reports - November 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Helmet CPAP as a Bridge From a Rapid Response Activation for Hypoxia Through Awake Tracheostomy in the Operating Room in a Patient With a Difficult Airway: A Case Report
Continuous positive airway pressure (CPAP) has been used in multiple clinical settings with increasing frequency. However, its use in improving blood oxygenation for difficult airways has never been a specific consideration. Here, we present a rapid response team (RRT) intervention in a patient with severe hypoxia requiring emergent surgical tracheostomy. To restore an adequate level of blood oxygen saturation, helmet CPAP was used during transportation and surgical tracheostomy. In selected cases involving difficult airways, helmet CPAP may have some advantages. Additional studies are warranted to assess the benefits of i...
Source: A&A Case Reports - November 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Syndrome of Inappropriate Antidiuretic Hormone Release During Ketamine Infusion in Complex Regional Syndrome Patient Receiving Intrathecal Baclofen: A Case Report
Complex regional pain syndrome (CRPS) is a severely disabling condition that typically develops after an inciting traumatic event. Ketamine infusion in subanesthetic dose provides sustained analgesia in selected cases of CRPS. In general, ketamine treatment does not significantly affect electrolyte or water balance. Here, we report a case of a CRPS patient on intrathecal baclofen pump developing syndrome of inappropriate antidiuretic hormone release (SIADH) during ketamine infusion. Prophylactic treatment with intravenous loop diuretics was successful in preventing the development of SIADH during ketamine infusion during s...
Source: A&A Case Reports - November 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Role of Ultrasound in Emergency Front of Neck Access: A Case Report and Review of Literature
We report a case of a patient who presented to the emergency department (ED) in extremis with a difficult airway. A history of multiple neck surgeries and permanent tracheostomy from birth until the age of 17 years complicated his airway management. Altered neck anatomy led to failed intubation and oxygenation. EFONA was established with the use of rapid ultrasound imaging and using the scalpel-bougie-tube technique. We present a review of literature relating to the use of ultrasound during emergency airway management. (Source: A&A Case Reports)
Source: A&A Case Reports - November 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Pulmonary Hypertensive Crisis During General Anesthesia in a 3-Year-Old Autistic Boy With Undiagnosed Scurvy, Undergoing Cardiac Catheterization: A Case Report
We describe the case of a 3-year-old autistic boy with undiagnosed scurvy who was scheduled for cardiac catheterization. Immediately after induction, the patient became hemodynamically unstable, which worsened with administration of nitrous oxide. Cardiac catheterization revealed pulmonary hypertension, which dramatically improved with administration of vitamin C. Anesthesiologists should be aware that scurvy is more common than previously thought, even in developed countries and can cause unexpected circulatory collapse from pulmonary hypertensive crisis. (Source: A&A Case Reports)
Source: A&A Case Reports - November 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Physical Dependence in Patient With Chronic Low Back Pain Treated With Topiramate: A Case Report
In the last decade, prescription of anticonvulsants for treatment of low back pain (LBP) increased 4-fold. Among them, topiramate has frequent side effects and a mechanism of action that is not fully understood. The authors describe a 65-year-old woman with dependence on topiramate prescribed for chronic LBP and discuss how she was successfully weaned off topiramate using duloxetine. A significant agonistic effect by topiramate on α-2 adrenergic receptors in the brain likely accounts for the symptoms of withdrawal that were seen. We attribute the resolution of her topiramate withdrawal symptoms to reduced norepinephr...
Source: A&A Case Reports - November 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Painful Inguinal Angiomyomatous Hamartoma Responsive to Conservative Pain Management: A Case Report
Angiomyomatous hamartoma (AMH) is a rare and benign mixed-tissue tumor of the lymphatic system. The majority of AMH tumors are removed surgically for cosmetic reasons or during workup of lymphadenopathy. There are few reported cases of this condition in the literature; AMH does not cause pain, and there are no published reports of AMH recurring after surgical excision. Here, we report a unique case of inguinal AMH recurring after surgical excision and causing a painful compression neuropathy. Our report also describes the patient’s successful but transient response to nonsurgical pain management. (Source: A&A Case Reports)
Source: A&A Case Reports - November 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Intraoperative Placement of Paravertebral Catheters to Manage Postoperative Pain in Opioid-Dependent Patients After Thoracolumbar Spine Fusion Surgery: A Case Report
We introduce a regional technique that involves the intraoperative placement of bilateral paravertebral catheters under direct visualization. The patient had stage IV lung cancer and was on chronic oxycodone therapy. He presented with a T10 metastatic lesion, and underwent spinal decompression with T7–L1 fusion and T10 corpectomy. Before fascial closure, catheters were advanced into the T10 paravertebral space under direct visualization by the surgeon bilaterally. Postoperatively, his pain was well controlled, and narcotic requirements were decreased. Our case report demonstrates that for patients undergoing posterio...
Source: A&A Case Reports - November 15, 2019 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, 2019 Category: Anesthesiology Tags: Letters to the Editor Source Type: research

Heparin-Induced Thrombocytopenia and Cardiac Surgery: Can We Do It All With Cangrelor?
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - November 1, 2019 Category: Anesthesiology Tags: Letters to the Editor Source Type: research

The Ventrain Device: A Future Role in Difficult Airway Algorithms?
The Ventrain is a small, manually operated, single-use, inspiratory flow-adjustable ventilation device that generates positive pressure during inspiration and, through a Bernoulli effect within the device, active suction during expiration. It was designed to provide emergency ventilation during airway obstruction via narrow-bore cannulae. The device has been used successfully in elective procedures lasting>1 hour. It remains to be seen if its theoretical advantages in “can’t intubate, can’t oxygenate” (CICO) scenarios translate to reliable clinical benefit and allow inclusion in future airway alg...
Source: A&A Case Reports - November 1, 2019 Category: Anesthesiology Tags: Innovation Source Type: research

Absence of Adverse Neurological Outcomes in a Non-Neurologically Injured Polytrauma Patient Despite Extreme and Prolonged Treatment-Resistant Hypotension: A Case Report
Temporary hypotension after severe trauma might help achieve hemostasis and increase the chances of survival. However, excessive hypotension can lead to adverse neurological sequelae or be fatal. The relationship between the degree of hypotension and neurological prognosis after trauma is not fully understood. Our report describes a patient with severe trauma who survived with a favorable neurological outcome despite extreme and prolonged treatment-resistant hypotension. (Source: A&A Case Reports)
Source: A&A Case Reports - November 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

A Safe Method for Performing an Epidural Blood Patch in a Pediatric Patient Requiring Deep Sedation for Epidural Catheter Placement: A Case Report
A 17-year-old boy developed postdural puncture headache after several lumbar punctures (LPs) for intrathecal chemotherapy. The pediatric anesthesiology service was consulted for an epidural blood patch (EBP). Sedation was required for the LPs, which made performing an EBP problematic because of the need for the patient to be conscious and able to report symptoms during injection of blood. An epidural catheter was placed after the next LP while the patient was sedated. After he woke up, blood was injected through the catheter and the headache resolved. This technique can be used in pediatric patients requiring deep sedation...
Source: A&A Case Reports - November 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Atrioesophageal Fistula After Radiofrequency Ablation Presenting With Status Epilepticus: A Case Report
Radiofrequency (RF) ablation for atrial fibrillation is commonly performed. Atrioesophageal fistulas are an uncommon complication of RF ablation and can present with status epilepticus due to an extensive vascular air embolus. Initial treatment may require a high level of suspicion of this rare occurrence to help prevent further injury and increase the likelihood of a meaningful recovery. (Source: A&A Case Reports)
Source: A&A Case Reports - November 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Bilateral Cavernous Sinus Syndrome, Pituitary Macroadenoma, and Postoperative Loss of Vision: A Case Report
We report a case of postoperative bilateral visual field deficits with concomitant complete bilateral ophthalmoplegia in a patient with a known pituitary macroadenoma after surgical excision of a small cell carcinoma of the bladder. Emergency postoperative imaging showed that the macroadenoma had increased in size and was associated with new right optic nerve edema. The patient underwent urgent excision of the macroadenoma 5 days after the onset of symptoms. Visual field deficits and associated ophthalmoplegia had completely resolved at 3-month follow-up. (Source: A&A Case Reports)
Source: A&A Case Reports - November 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Anesthesia in the Form of Audiovisual Distraction for a Child Requiring Surgery With End-Stage Cardiomyopathy: A Case Report
Anesthetizing children with extreme cardiopulmonary illness can be especially challenging. In adults, a host of alternatives to general anesthesia for the labile patient are available, However, in children, these techniques may be challenging due to a lack of patient cooperation. Distraction techniques have been successfully used to reduce procedural pain. The patient whose case is reported here required surgery for inguinal hernia repair after repeated bowel incarceration. Due to severe end-stage cardiomyopathy, the risk of general anesthesia was deemed excessive. Distraction was used to usher the patient through an awake...
Source: A&A Case Reports - November 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Catastrophic Intracardiac Thrombosis During Emergency Repair of an Expanding Aortic Pseudoaneurysm: A Case Report
We report the case of a 41-year-old female taken to the operating room for repair of an expanding ascending aortic pseudoaneurysm. Following a prolonged operation, she developed intracardiac thrombus during transfusion of hemostatic blood products and procoagulant agents. Potential contributing factors are discussed. (Source: A&A Case Reports)
Source: A&A Case Reports - November 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Suture Catheter for Rescue Perineural Catheter Placement When Unable to Position a Conventional Through-the-Needle Catheter: A Case Report
The main purported benefit of suture-style catheters is the ability to secure the catheter at 2 sites, thereby decreasing the likelihood of catheter dislodgement. An additional benefit is the ability to precisely control the placement of the orifice to infuse local anesthetic. Here we present the case of a patient undergoing open ankle surgery for whom placement of a conventional through-the-needle popliteal sciatic perineural catheter for postoperative analgesia was attempted. Despite multiple attempts, the catheter repeatedly advanced beyond the nerve. Placement of a suture catheter was then attempted, and the catheter w...
Source: A&A Case Reports - November 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Continuous Intravenous Lidocaine as an Effective Pain Adjunct for Opioid-Induced Bowel Dysfunction: A Case Report
This case study describes a patient with suspected opioid-induced bowel dysfunction who had improved pain control when treated with intravenous (IV) lidocaine. An 80-year-old man with failed back surgery syndrome managed with an intrathecal (IT) pump presented with protracted abdominal pain. The acute pain service initiated a lidocaine infusion at 1 mg·min−1, and the patient reported significant pain relief. The patient experienced refractory abdominal pain with 3 attempts to wean the lidocaine infusion. Eventually, a successful transitional regimen was achieved with methylnaltrexone and transdermal lidocaine ...
Source: A&A Case Reports - November 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Erector Spinae Plane Blocks in Major Hepatopancreaticobiliary Surgery: A Case Series
We describe a series of 3 cases that illustrate the efficacy of ESP blocks after major HPB surgery. (Source: A&A Case Reports)
Source: A&A Case Reports - November 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Neuropathic Pain due to Neurofibromatosis Treated With Transcutaneous Electrical Nerve Stimulation in a Pregnant Patient: A Case Report
A patient with neurofibromatosis type 1 presented to the pain clinic with neuropathic pain. Thoracolumbar magnetic resonance imagining revealed meningocele T12–L2 with cauda equina distortion. After becoming pregnant, the patient interrupted opioid treatment, refusing pharmacological treatment until the pain became unbearable. Transcutaneous electrical nerve stimulation (TENS) was proposed. The patient used this treatment from the first trimester until month 6 postpartum, achieving good analgesia without any adverse effects for the mother or child. TENS may be a viable treatment for neuropathic pain (NP) during pregn...
Source: A&A Case Reports - November 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

A Guide for Submitting a Manuscript That Is Aligned With the Mission of A&A Practice
Anesthesia & Analgesia (A&A) Practice is a journal for clinicians worldwide. It is aligned with the educational mission of its parent organization, the International Anesthesia Research Society. A&A Practice is an online-only companion journal of A&A. A&A Practice seeks to publish short yet informative, peer-reviewed, PubMed indexed articles that offer a solution to a perioperative care or patient safety conundrum or a health management issue, which is communicated as one of the several manuscript types. We herein provide authors with a guide to assist them toward a successfully published manuscript in ...
Source: A&A Case Reports - October 15, 2019 Category: Anesthesiology Tags: Educational Tool Source Type: research

Bilateral Visual Loss After Spine Surgery in a Patient With Midfacial Trauma: A Case Report
We present a case of bilateral visual loss in a patient who underwent spine surgery after sustaining a fall and trauma to her face and cervical spine. Visual loss in the right eye, not recognized until after surgery, was a result of blunt injury to the eye. Visual loss in the left eye was caused by posterior ischemic optic neuropathy, an unfortunate complication of surgery in the prone position. (Source: A&A Case Reports)
Source: A&A Case Reports - October 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Intravenous Ketamine as an Adjunct for Pachyonychia Congenita–Associated Pain: A Case Report
Pachyonychia congenita (PC) is a rare, inherited disorder of keratin filaments characterized by palmoplantar hyperkeratosis, keratoderma, and extreme pain. Management is largely symptomatic and typically involves multimodal pain control strategies. Here, we report the treatment of one 21-year-old man’s refractory neuropathic PC pain with a 4-day inpatient ketamine infusion. Within 1 night of beginning treatment, his pain diminished to a 0/10 without any adverse effects, with effects lasting 2 weeks. No reported PC pain regimens have made use of intravenous ketamine; thus, we suggest recurrent ketamine infusions as an...
Source: A&A Case Reports - October 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Total Hip Replacement in a Patient With a Fontan Circulation: A Case Report
We describe the perioperative management of a patient with a Fontan circulation undergoing total hip arthroplasty using combined spinal–epidural anesthesia and discuss the issues requiring special consideration for this surgical procedure in this group of patients. (Source: A&A Case Reports)
Source: A&A Case Reports - October 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Retained Perineural Catheter: A Sentinel Case Report
We report the rare complication of a retained peripheral nerve block catheter (PNBC). A 45-year-old man with intractable postamputation phantom limb pain was treated with continuous infusions via femoral and sciatic peripheral nerve catheters. The catheters were removed by an emergency department physician 2 days after placement. Five months later, the patient presented with a discharging sinus from the sciatic nerve catheter site. Magnetic resonance imaging (MRI) was inconclusive. Surgical exploration showed 15 cm of retained peripheral nerve catheter, which was removed. (Source: A&A Case Reports)
Source: A&A Case Reports - October 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

A Case Report of Surgical Entrapment and Catheter Embolization: A Rare Complication of Peripherally Inserted Central Catheters
In this report, we describe a rare scenario of catheter breakage, entrapment, and embolization in a patient caused by inadvertent surgical clip and suture placement. (Source: A&A Case Reports)
Source: A&A Case Reports - October 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Antiphospholipid Syndrome During Septic Shock: Hyper- or Hypocoagulability?: A Case Report
We report the clinical case of a septic patient with antiphospholipid syndrome who developed ischemia in all 4 limbs, despite a normal systemic blood pressure. Prolonged coagulation times suggested a hemorrhagic diathesis, requiring transfusion of fresh-frozen plasma and discontinuation of heparin infusion. In contrast, the study of the viscoelastic properties of the clot by thromboelastography suggested an uncontrolled activation of the coagulation cascade. This observation led to the reintroduction of heparin with improvement in the patient’s laboratory findings. Anesthesiologists should consider thromboelastograph...
Source: A&A Case Reports - October 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Pancreaticoduodenectomy (Whipple Procedure) in a Toddler: An Anesthesia Case Report
We present our anesthetic management of an 18-month-old girl who underwent a Whipple procedure for a mass in the head of the pancreas that was causing obstructive cholangiopathy. We explore the differences between pediatric and adult patients presenting for Whipple procedure, with a focus on pediatric anesthetic management. Key considerations include blood and fluid management, perioperative analgesia, and postoperative care. (Source: A&A Case Reports)
Source: A&A Case Reports - October 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Postpartum Thyroid Storm in Poorly Controlled Graves’ Disease: A Case Report
Hyperthyroidism during pregnancy is a relatively rare event, but poor control of hyperthyroidism during pregnancy is associated with a host of issues. These include intrauterine fetal demise, hypertensive disorders of pregnancy, preterm delivery, low birth weight, intrauterine growth restriction, and maternal congestive heart failure. One of the most feared sequelae of hyperthyroidism is thyroid storm, which has a mortality rate>10%. Patients who develop thyroid storm present several challenges to anesthesiologists including hemodynamic instability and medication management. Here, we present the anesthetic management fo...
Source: A&A Case Reports - October 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Delayed Neuromuscular Blockade Reversal With Sugammadex After Vecuronium, Desflurane, and Magnesium Administration: A Case Report
We present a patient who underwent general anesthesia using desflurane, vecuronium, and magnesium infusion with delayed neuromuscular blockade reversal after sugammadex administration. A higher than anticipated total dose of sugammadex was required for adequate reversal, and quantitative neuromuscular monitoring was essential to ensuring complete neuromuscular recovery before extubation in this case. (Source: A&A Case Reports)
Source: A&A Case Reports - October 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Analgesic Rescue With Opioid-Only Thoracic Epidural After Surgical Infiltration of Liposomal Bupivacaine: A Case Report
We present the case of a 51-year-old man with a history of recurrent lung cancer after left upper lobectomy who presented for an elective completion pneumonectomy via a bilateral anterior thoracotomy incision. At the completion of surgery, bilateral multilevel intercostal infiltration was performed with liposomal bupivacaine. Due to poorly controlled postoperative pain after extubation, a thoracic epidural was placed in the intensive care unit. An opioid-only infusion was started and transitioned to a local anesthetic–based infusion on postoperative day 2. This case report represents a novel stepwise approach of thor...
Source: A&A Case Reports - October 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Brain Tumor, Pheochromocytoma, and Pregnancy: A Case Report of a Cesarean Delivery in a Patient With Von Hippel–Lindau Disease
A young woman first diagnosed with von Hippel–Lindau disease (VHL) during pregnancy underwent an uncomplicated cesarean delivery despite having multiple classic VHL tumors, including a large cerebellopontine brain mass and vasoactive pheochromocytoma. Patients with VHL may have multiple tumors of the central nervous system and viscera that greatly impact anesthetic management. This case highlights the anesthetic considerations for a parturient with pheochromocytoma and elevated intracranial pressure, as well as the importance of a multidisciplinary team approach. (Source: A&A Case Reports)
Source: A&A Case Reports - October 15, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Point-of-Care Lung Ultrasound for Bronchial Blocker Placement
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2019 Category: Anesthesiology Tags: Letter to the Editor Source Type: research

Prolapse of Aortic Right Coronary Cusp Causing Right Ventricular Outflow Tract Obstruction in a Child With Large Ventricular Septal Defect
No abstract available (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2019 Category: Anesthesiology Tags: Echo Rounds Source Type: research

Cardiovascular Collapse in a Patient With Parotid Abscess: Dangerous Cross Talk Between the Brain and Heart: A Case Report
We present the case of a patient with a parotid abscess, which developed as a complication of his otolaryngologic surgery, and which led to repeated episodes of symptomatic bradycardia associated with cardiovascular collapse. This case highlights the importance of heightened awareness, early diagnosis, and timely treatment of postsurgical neuropathic pain syndromes to avoid life-threatening complications. (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Abdominal Surgery With Bilateral Rectus Sheath Block: A Case Report
A 44-year-old man, American Society of Anesthesiologists physical status class IV, presented for fulguration of anal condyloma and diverting colostomy. The patient’s medical history includes World Health Organization (WHO) class I pulmonary hypertension (PH), right heart failure, and bilateral lower extremity paralysis due to Pott’s disease. The patient was not a candidate for neuraxial anesthesia due to sacral decubitus ulcers, and alternative options to general anesthesia (GA) were considered to avoid the high risk of right ventricular (RV) failure and ensuing complications. The case was successfully performe...
Source: A&A Case Reports - October 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Decreasing Frontal Electroencephalogram Alpha Power and Increasing Sensitivity to Volatile Anesthetics Over 3 Surgeries Within 7 Months: A Case Report
We present a case of a patient undergoing 3 cardiac operations within 7 months with severe illness and comorbidity, leading to pronounced physical frailty and significant changes of frontal alpha power in the EEG and increased sensitivity to volatile anesthetics. These findings may have important clinical implications and should trigger further investigations on this topic. (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Andexanet Alfa for Urgent Reversal of Apixaban Before Aortic Surgery Requiring Cardiopulmonary Bypass: A Case Report
We present an adult patient on apixaban for nonvalvular atrial fibrillation who required urgent reoperative aortic surgery for an aortic root pseudoaneurysm. Apixaban was reversed with andexanet alfa. A second dose of andexanet alfa was required before surgical incision for persistently elevated antifactor Xa levels. Intraoperative management required use of cardiopulmonary bypass (CPB). No major adverse cardiovascular, cerebrovascular, hemorrhagic, or thromboembolic events were observed. (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Massive Fetal Transfusion During an Emergency Ex Utero Intrapartum Treatment for a Congenital Infantile Fibrosarcoma: A Case Report
We describe the case of an infantile fibrosarcoma (IFS) that presented with fetal hydrops and was successfully managed with an emergency EXIT that necessitated the initiation of a massive fetal blood transfusion both with and without the support of uteroplacental circulation. (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Splenic Rupture and Postpartum Hemorrhage After Emergent Cesarean Delivery: A Case Report
Postpartum hemorrhage is a leading cause of maternal and fetal mortality. Although rare, peripartum splenic rupture (PSR) is a lethal cause of bleeding due to variable presentation and delayed diagnosis. A 22-year-old gravida 2, para 0, abortus 1 (G2P0A1) woman presented for premature rupture of membranes and was diagnosed with Influenza A and chorioamnionitis. She underwent emergent cesarean delivery under general anesthesia. Postoperatively, her condition worsened despite treatment for presumed sepsis. She was taken to the operating room for an exploratory laparotomy, and a splenectomy was performed for splenic rupture. ...
Source: A&A Case Reports - October 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Repeated Intercostal Nerve Blocks With Liposomal Bupivacaine for Chronic Chest Pain: A Case Report
Chronic chest pain is a debilitating condition that is poorly treated, resulting in opioid dependence and significantly decreased quality of life. In this case report, we describe the successful use of 266 mg of liposomal bupivacaine for 4 rounds of left-sided multilevel intercostal nerve blocks performed to treat chronic chest pain of a 21-year-old woman (150 kg, 163 cm). The sensory blockade duration was up to 7 days, analgesia lasted 2 months, and was described superior to that with ropivacaine intercostal blockade. The treatment improved satisfaction with pain control and quality of life. (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Adjustable Pressure Limit Valve Failure During Intraoperative Care: A Case Report
We report an unusual case where a crack in the APL valve allowed release of pressure from within the circuit resulting in ineffective bag-valve-mask ventilation of an infant. The appropriate steps to prevent such issues are reviewed, and an algorithm to quickly identify such intraoperative problems is presented. (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Lung Isolation for Whole Lung Lavage in a Pediatric Patient With Atypical Airway Anatomy due to Short Stature: A Case Report
This case demonstrates the airway management of a pediatric patient with short stature due to STAT5b deficiency, a rare genetic immunodeficiency associated with lung disease and endocrinopathy. The patient had recurrent pulmonary infections and pulmonary alveolar proteinosis (PAP) for which whole lung lavage (WLL) was recommended. Due to short stature and overall body habitus, the patient’s airway would not accommodate a traditional double-lumen tube (DLT). Therefore, we placed 2 single-lumen breathing tubes: 1 endobronchial and 1 endotracheal, to mimic a DLT and facilitate WLL, demonstrating a viable option for lung...
Source: A&A Case Reports - October 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research

Having a Conscious Patient During Cardiopulmonary Resuscitation: Is It Not Time to Consider Sedation Protocol?: A Case Report
A middle-aged man with acute inferior wall myocardial infarction was admitted in cardiac arrest and in an unresponsive state to the hospital. Cardiopulmonary resuscitation (CPR) was initiated. Patient showed signs of consciousness throughout the CPR. The impact of awareness during CPR on the neuropsychological status of a patient with a favorable neurological outcome is yet to be studied on a large scale. Sedation protocol without compromising hemodynamic status may prove a fair choice in such cases. (Source: A&A Case Reports)
Source: A&A Case Reports - October 1, 2019 Category: Anesthesiology Tags: Case Reports Source Type: research