Successful Resuscitation Following Intraoperative Acute Pulmonary Embolism With a Focus on Control of Bleeding After Thrombolytic Therapy: A Case Report
We report a case of acute pulmonary embolism with cardiopulmonary arrest during orthopedic surgery. Prompt thrombolysis and gaining control of both thrombolytic therapy-induced bleeding from the wound and a hepatic cyst enabled the patient to recover without neurological deficits. (Source: A&A Case Reports)
Source: A&A Case Reports - December 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Hereditary Antithrombin Deficiency: A Balancing Act of Perioperative Hemostasis and Thromboprophylaxis—A Case Report
We present a case of a 65-year-old woman with inherited AT deficiency with history of multiple VTEs who was admitted for presurgical anticoagulant bridging before microvascular decompression craniotomy for trigeminal neuralgia. (Source: A&A Case Reports)
Source: A&A Case Reports - December 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Right Ventricular Outflow Tract Obstruction in the Intensive Care Unit: A Case Report of 2 Patients
We report the first cases of RVOTO diagnosed in the ICU using continuous right ventricular pressure waveform monitoring. Our 2 cases reflect both mechanical and dynamic causes of obstruction, each of which require different approaches to treatment. Inotrope use can exacerbate RVOTO caused by dynamic etiology, whereas surgery is usually the treatment of choice for mechanical obstructions. Inability to recognize RVOTO or the correct etiology can lead to hemodynamic compromise and poor outcomes. (Source: A&A Case Reports)
Source: A&A Case Reports - December 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Transesophageal Echocardiography–Guided Aspiration of Venous Air Embolism During Liver Transplantation: A Case Report
Transesophageal echocardiography can be useful not only in diagnosing venous air embolism but also in guiding aspiration of air from the pulmonary artery. A 59-year-old man with a history of cirrhosis underwent combined kidney and liver transplantations. He developed acute hypotension after the native liver was removed due to a massive venous air embolism via a retained transjugular intrahepatic portosystemic shunt catheter. Transesophageal echocardiography revealed air in the pulmonary artery resulting in outflow obstruction. Under echocardiographic guidance, the pulmonary arterial catheter was withdrawn to the air pocket...
Source: A&A Case Reports - December 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Challenges in Obstetric Anesthesia in a Parturient With Native American Myopathy: A Case Report
In this report, we present the anesthetic management of a parturient with NAM and previous extensive posterior spinal fusion undergoing cesarean delivery under general anesthesia. (Source: A&A Case Reports)
Source: A&A Case Reports - December 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Two Cases of Extensive Venous Thrombosis Incidentally Discovered With Bedside Ultrasound for Intravenous Access
We report 2 cases of diagnosis of DVT that resulted from ultrasound for difficult peripheral venous access. In the course of ultrasound-guided procedures, anesthesiologists are in a position to incidentally discover DVT and potentially change management to reduce the likelihood of DVT leading to pulmonary embolism. (Source: A&A Case Reports)
Source: A&A Case Reports - November 1, 2021 Category: Anesthesiology Tags: Diagnostic Ultrasound Rounds Source Type: research
Low Prevalence of Designated Lactation Spaces at Hospitals and Ambulatory Surgery Centers in Iowa: An Educational Tool for Graduates’ Job Selection
Many anesthesiologists and nurse anesthetists want to continue breastfeeding their babies when returning to work from maternity leave. The cornerstone of breast milk supply maintenance is breast milk pumping sessions at regular intervals. These breast milk pumping sessions require time and private space for lactation. We surveyed Iowa hospitals and ambulatory surgery centers and created an educational spreadsheet to guide inquiry and postgraduate job selection of our anesthesiology residents and nurse anesthetist students (eg, when considering future family planning). The survey and spreadsheet showed a low prevalence of d...
Source: A&A Case Reports - November 1, 2021 Category: Anesthesiology Tags: Educational Tool Source Type: research
Intraoperative Management for Left Ventricular Assist Device Implantation With Concurrent Laparoscopic Sleeve Gastrectomy: A Case Series
This report describes intraoperative considerations for patients who underwent LVAD implantation with concurrent laparoscopic sleeve gastrectomy (LSG) to promote weight loss. In particular, right ventricular dysfunction associated with acute left ventricular unloading may be compounded by pneumoperitoneum for LSG due to the difficulty in ventilating patients with obesity, hypercarbia-mediated increase in pulmonary vascular resistance, and variable cardiac loading conditions. We identify specific anesthetic challenges and discuss methods of monitoring and management. (Source: A&A Case Reports)
Source: A&A Case Reports - November 1, 2021 Category: Anesthesiology Tags: Case Series Source Type: research
Expanded Perineal Coverage With Combined Pudendal and Inferior Cluneal Nerve Blocks: A Case Report
We present a case report of a 6-year-old female who presented for surgical resection of widespread condylomata accuminata involving the perineum and buttocks. Analgesia was achieved using a combined PN and inferior cluneal nerve block. To our knowledge, this is the first report of this combined technique used for perioperative analgesia. (Source: A&A Case Reports)
Source: A&A Case Reports - November 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Midazolam-Induced Hiccups Reversed by Flumazenil: A Case Report
We describe a patient who developed hiccups lasting 9 days following an orthopedic surgery and again developed hiccups during a subsequent surgery after only having received midazolam; flumazenil administration led to sustained cessation of his hiccup symptoms immediately. (Source: A&A Case Reports)
Source: A&A Case Reports - November 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Malignant Hyperthermia During Cardiac Surgery Successfully Treated by Deep Hypothermia Using Cardiopulmonary Bypass: A Case Report
We report a case of a 58-year-old patient with a type-A aortic dissection. After induction of general anesthesia, a hypermetabolic reaction was successfully treated by deep hypothermia using cardiopulmonary bypass. Dantrolene became available in theater after the hypermetabolism was already treated successfully by hypothermia. Because of a low suspicion of MH, dantrolene was not administered when it became available. The patient fully recovered, and MH susceptibility was confirmed. Cardiopulmonary bypass should be considered to treat MH in case dantrolene and conservative therapy are unavailable or insufficient. (Source: A&A Case Reports)
Source: A&A Case Reports - November 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Erector Spinae Plane Continuous Catheters for Refractory Abdominal Pain Related to Necrotizing Pancreatitis: A Case Report
Erector spinae plane (ESP) continuous catheters are used for the management of postsurgical pain. The use of these catheters for acute nonsurgical abdominal pain is not well defined. This case describes a patient with refractory abdominal pain secondary to necrotizing pancreatitis despite escalating doses of opioids, ketamine, and dexmedetomidine. Our patient declined epidural analgesia. Bilateral ESP continuous catheters successfully controlled her pain, and she was weaned off of all analgesics during the week following catheter placement. This case demonstrates that ESP continuous catheters can be considered for patients...
Source: A&A Case Reports - November 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Changes in the Nociception Level Index During Surgical Resection of Paragangliomas: A Case Report
We describe a pediatric case of an open resection of paraganglionic masses during which episodic increases in NOL index and blood pressure coincided with tumor manipulation, presumably due to a catecholamine surge. Since the patient was under stable and adequate analgesia, the increases in NOL index likely reflected the physiologic effects of tumor handling rather that the presence of a true noxious stimulus. Clinicians should consider this limitation when using this monitor. (Source: A&A Case Reports)
Source: A&A Case Reports - November 1, 2021 Category: Anesthesiology Tags: Case Report Source Type: research
Successful Implementation of a Robust Medical Student Curriculum in Anesthesiology
Increasing medical student enrollment creates challenges for clinical course directors to accommodate students and to provide consistency in clinical experiences. We discuss curricular modifications addressing these challenges specific to anesthesiology electives through the creation of 2-week anesthesiology electives to provide scheduling flexibility in the clinical years. We also incorporated curricular enhancements as a consistent didactic framework congruent with the clinical experience. Since initiating these electives in 2017, annual student enrollment increased>33%. More fourth-year students have enrolled in these c...
Source: A&A Case Reports - October 1, 2021 Category: Anesthesiology Tags: Educational Tool Source Type: research
Bain H: Innovative Modification of Bain Circuit for the Resuscitation and Transportation of Patients With Coronavirus Disease 2019
Bain H circuit is an innovatively modified breathing circuit designed for the transportation and resuscitation of patients with coronavirus disease (COVID-19). For this circuit, the Heidbrink valve was replaced with a 15F inlet and 15M/22F outlet adjustable pressure-limiting (APL) valve, and a high-efficiency particulate air filter was placed over the APL outlet valve. The circuit is designed to filter the novel coronavirus without any increase in dead space or resistance. All benefits of the conventional Bain circuit were retained. Besides its use in dedicated COVID-19 areas, this circuit can be used in other emergency un...
Source: A&A Case Reports - October 1, 2021 Category: Anesthesiology Tags: Innovation Source Type: research
