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Case Reports in Anesthesiology

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https://www.readbyqxmd.com/read/30420923/use-of-awake-flexible-fiberoptic-bronchoscopic-nasal-intubation-in-secure-airway-management-for-reconstructive-surgery-in-a-pediatric-patient-with-burn-contracture-of-the-neck
#1
Tolga Totoz, Kerem Erkalp, Sirin Taskin, Ummahan Dalkilinc, Aysin Selcan
Although the use of awake flexible fiberoptic bronchoscopic (FFB) intubation is a well-recognized airway management technique in patients with difficult airway, its use in smaller children with burn contractures or in an uncooperative older child may be challenging. Herein, we report successful management of difficult airway in a 7-year-old boy with burn contracture of the neck, by application of FFB nasal intubation in a stepwise approach, first during an initial preoperative trial phase to increase patient cooperation and then during anesthesia induction for the reconstructive surgery planned for burn scars and contractures...
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/30416830/pharmacological-management-of-severe-neuropathic-pain-in-a-case-of-eosinophilic-meningitis-related-to-angiostrongylus-cantonensis
#2
Jennifer Busse, David Gottlieb, Krystal Ferreras, Jennifer Bain, William Schechter
Angiostrongylus cantonensis, the rat lungworm, is the most common infectious cause of eosinophilic meningitis and can be fatal. The parasite can be found throughout Southeast Asia and Pacific Islands and the global distribution is expanding. We present the case of a fourteen-year-old female who had previously traveled to Hawaii and developed severe neuropathic pain related to A. cantonensis infection refractory to gabapentin and pregabalin monotherapy, who was eventually managed with an ultralow dose ketamine infusion, methadone, and serotonin-norepinephrine reuptake inhibitor...
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/30364012/early-detection-and-management-of-massive-intraoperative-pulmonary-embolism-in-a-patient-undergoing-repair-of-a-traumatic-acetabular-fracture
#3
Tobechi E Okoronkwo, XueWei Zhang, Jessica Dworet, Matthew Wecksell
A 73-year-old male with history of hyperlipidemia and osteoarthritis was transferred from an outside hospital after a fall from a ladder at home. He sustained a severe right sided acetabular fracture involving the femoral head, requiring operative repair. Preoperative evaluation was unremarkable except for oxygen saturation < 95 %. After induction of anesthesia and surgical positioning, the patient went into cardiac arrest. After intraoperative cardiopulmonary resuscitation (CPR) and placement on extracorporeal membrane oxygenation (ECMO), the patient stabilized...
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/30356382/intrathecal-pump-implantation-in-the-cisterna-magna-for-treating-intractable-cancer-pain
#4
Yaling Lou, Yuefeng Rao, Zhiying Feng
A 54-year-old male patient with postoperative axillary lymph node, intrapulmonary, intracranial, and cervical spine metastases of left liver cancer was suffering from severe, persistent, and pricking pain in the right dorsal shoulder and right arm since 3 months. The drug dose of the fentanyl transdermal patch was gradually increased after admission and an adjuvant analgesic was also included, but neither treatment alleviated the pain. It was gradually alleviated after intramedullary analgesic infusion through intrathecal pump implantation in cistern magna...
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/30225146/preoperative-fasting-guidelines-in-children-should-they-be-revised
#5
Hazem Kafrouni, Rami El Ojaimi
Children presenting with ingestion of foreign bodies need gastroscopy as a primary management modality. A controversy lies regarding guidelines for preoperative fasting among children with low risk of aspiration and intraoperative complications. This case report represents cases of children who ingested foreign bodies and underwent fasting at different times preoperatively. With mounting evidence questioning the benefits of long durations of fasting in decreasing the risk of aspiration and with studies showing that fasting for more than 2 hours after ingestion of clear fluid does not significantly alter gastric pH or volume, these incidental findings raise the question of whether it is safe to keep children NPO, for a shorter duration before the administration of anesthesia...
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/30210875/erratum-to-quadratus-lumborum-block-as-sole-homeostatic-preserving-anesthetic-for-a-patient-with-multiple-system-atrophy-undergoing-open-inguinal-hernia-repair-a-case-report
#6
Luca La Colla, Rebecca Schroeder
[This corrects the article DOI: 10.1155/2018/7161860.].
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/30186636/case-report-of-a-massive-thigh-hematoma-after-adductor-canal-block-in-a-morbidly-obese-woman-anticoagulated-with-apixaban
#7
Katherine L Koniuch, Bradley Harris, Michael J Buys, Adam W Meier
Hematoma formation after peripheral nerve block placement is a rare event. We report a case of a morbidly obese patient who was anticoagulated with apixaban and developed a massive thigh hematoma after an ultrasound-guided adductor canal block. Despite continuous visualization of the block needle, an unrecognized vascular injury occurred leading to a 14-cm hematoma in the anterolateral thigh. Morbid obesity warrants additional risk consideration when placing nerve blocks in an anticoagulated patient. In addition, early recognition and expert consultation are both important in the management of block-related hematomas...
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/30147962/case-report-of-subanesthetic-intravenous-ketamine-infusion-for-the-treatment-of-neuropathic-pain-and-depression-with-suicidal-features-in-a-pediatric-patient
#8
Garret Weber, JuHan Yao, Shemeica Binns, Shinae Namkoong
Chronic neuropathic pain and depression are often comorbid. Ketamine has been used to treat refractory pain. There is emerging evidence for use in depression. We present a case of a pediatric patient who was successfully treated with subanesthetic intravenous ketamine infusion for chronic neuropathic pain and suicidality.
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/30112218/can-ace-i-be-a-silent-killer-while-normal-renal-functions-falsely-secure-us
#9
Ahmed Abdelaal Ahmed Mahmoud, Mark Campbell, Margarita Blajeva
The current case report represents a warning against serious hyperkalaemia and acidosis induced by ACE-I during surgical stress while normal renal function could deceive the attending anaesthetist. Arterial gas analysis for follow-up of haemoglobin loss accidentally discovered hyperkalaemia and acidosis. Glucose-insulin and furosemide successfully corrected hyperkalaemia after 25 minutes and acidosis after 3 hours. These complications could be explained by a deficient steroid stress response to surgery secondary to suppression by ACE-I...
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/30105100/ropivacaine-plasma-concentrations-after-192-hour-high-dose-epidural-ropivacaine-infusion-in-a-pediatric-patient-without-side-effects
#10
Glenn van de Vossenberg, Selina van der Wal, Andrea Müller, Edward Tan, Kris Vissers
This case report discusses continuous epidural administration of ropivacaine 0.56 mg kg-1 h -1 for 8 days in a 7-year-old trauma patient to prevent pain, after performing a lower right and upper left leg guillotine amputation. Venous sampling after 8 days revealed bound and unbound ropivacaine concentrations of 1.1 mg/l and 0.06 mg/l in plasma, respectively. Arterial sampling for bound and unbound ropivacaine was 1.2 mg/l and 0.05 mg/l in plasma, respectively. In this case report, long-term high dose epidural infiltration of ropivacaine did not result in severe side effects or complications...
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/30057825/percutaneous-epidural-hydrogel-sealant-for-the-treatment-of-spontaneous-intracranial-hypotension-a-case-report-of-chronic-thoracic-neuralgia-and-technical-lessons-learned
#11
Michael G Hillegass, Samuel F Luebbert, Maureen F McClenahan
We report a case in which a 34-year-old female with refractory intracranial hypotension headaches due to a spontaneous dural tear was ultimately treated with CT-guided transforaminal epidural placement of a synthetic absorbable sealant (DuraSeal®). The procedure successfully resolved her headaches; however she subsequently developed thoracic neuralgia presumably due to mass effect of the sealant material on the lower thoracic spinal cord and nerve roots. This case report describes the potential for significant spinal cord and nerve root compression as well as the development of chronic neuralgia with the placement of epidural hydrogel and fibrin glue sealants...
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/30050698/quadratus-lumborum-block-as-sole-homeostatic-preserving-anesthetic-for-a-patient-with-multiple-system-atrophy-undergoing-open-inguinal-hernia-repair-a-case-report
#12
M D Luca La Colla, R M D Schroeder
Quadratus Lumborum (QL) block has been successfully used for different abdominal procedures in the past. Multiple system atrophy (MSA) is a progressive neurodegenerative disorder characterized mainly by autonomic instability, motor impairment, and cognitive dysfunction. We report a case of a patient with MSA with a history of multiple episodes of unplanned admissions following outpatient minor surgical procedures under general anesthesia scheduled to undergo open inguinal hernia repair. In our patient, QL block was successfully used for surgical anesthesia and it resulted in hemodynamic stability and an opioid-free perioperative course...
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/29977620/glucose-management-during-insulinoma-resection-using-real-time-subcutaneous-continuous-glucose-monitoring
#13
Yuki Sugiyama, Chiaki Kiuchi, Maiko Suzuki, Yuki Maruyama, Ryo Wakabayashi, Yasunari Ohno, Shugo Takahata, Takumi Shibazaki, Mikito Kawamata
Insulinoma is a rare neuroendocrine tumor that causes hypoglycemia due to unregulated insulin secretion. Blood glucose management during insulinoma resection is therefore challenging. We present a case in which real-time subcutaneous continuous glucose monitoring (SCGM) in combination with intermittent blood glucose measurement was used for glycemic control during surgery for insulinoma resection. The SCGM system showed the trends and peak of interstitial glucose in response to glucose loading and the change of interstitial glucose before and after insulinoma resection...
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/29971168/hemodynamic-response-to-massive-bleeding-in-a-patient-with-congenital-insensitivity-to-pain-with-anhidrosis
#14
Yuki Sugiyama, Sayako Gotoh, Masatoshi Urasawa, Mikito Kawamata, Koichi Nakajima
A patient with congenital insensitivity to pain with anhidrosis (CIPA) underwent revision of total hip arthroplasty under general anesthesia with only propofol. During surgery, neither elevation of stress hormones nor hemodynamic changes associated with pain occurred; however, when blood was rapidly lost, compensatory tachycardia was observed. Although patients with CIPA are complicated with autonomic disturbance due to dysfunction of postganglionic sympathetic fibers, this compensatory response indicated that the adrenal glands in patients with CIPA secrete catecholamine as part of a compensatory response during bleeding under general anesthesia...
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/29951321/management-of-a-parturient-with-mast-cell-activation-syndrome-an-anesthesiologist-s-experience
#15
Sangeeta Kumaraswami, Gabriel Farkas
Mast cell activation syndrome (MCAS) is a disorder in which patients experience symptoms and signs attributable to inappropriate mast cell activation and mediator release. Multiorgan involvement in patients can result in significant morbidity and possible mortality. Limited literature exists regarding anesthetic management of patients with MCAS. We report a case of vaginal delivery with neuraxial labor analgesia in a parturient with this condition and highlight the importance of multidisciplinary planning for uneventful outcomes...
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/29862088/unexpected-exacerbation-of-tracheal-stenosis-in-a-patient-with-hunter-syndrome-undergoing-cardiac-surgery
#16
Nobue Terabe, Soichiro Yamashita, Makoto Tanaka
We report unexpected exacerbation of tracheal stenosis during general anesthesia in a 50-year-old patient with Hunter syndrome undergoing cardiac surgery for valvular disease. He had undergone cervical laminoplasty 3 months previously; at that time, his airway had been uneventfully managed. Preoperative flexible fiberoptic laryngoscopy showed a normal upper respiratory tract, but chest computed tomography showed tracheal stenosis that had flattened the lumen. The narrowest part above the tracheal bifurcation was 2 cm long and the anteroposterior diameter was ≤6 mm...
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/29854470/coccydynia-treated-with-dorsal-root-ganglion-stimulation
#17
Nicholas L Giordano, Noud van Helmond, Kenneth B Chapman
Coccydynia can be difficult to resolve with conventional treatment options. Dorsal root ganglion (DRG) stimulation has recently emerged as a treatment for chronic pain, but its application has not been described in the context of coccydynia. We used DRG stimulation treatment in a patient suffering from intractable coccyx pain. At long-term follow-up, the patient experienced a decrease in pain intensity and improvement in function, without any complications. DRG stimulation may be a treatment modality for coccydynia refractory to other approaches...
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/29854469/airway-management-during-thyroidectomy-for-a-giant-goitre-due-to-mccune-albright-syndrome
#18
Hiroyuki Nakao
There have been no case reports to date describing the technical aspects of tracheal intubation in a patient with a goitre associated with McCune-Albright syndrome (MAS), even though goitre is frequently observed in this condition. I describe a case of resection of a giant goitre in a patient with MAS, with difficult airway management. Preoperative investigation showed that the trachea was shifted to the right by the goitre, with the narrowest part of the tracheal lumen 4 mm in diameter. There was dome-shaped protuberance of the posterior pharyngeal wall into the airway...
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/29805812/erector-spinae-plane-block-for-elective-laparoscopic-cholecystectomy-in-the-ambulatory-surgical-setting
#19
Kjartan Eskjaer Hannig, Christian Jessen, Uday Kant Soni, Jens Børglum, Thomas Fichtner Bendtsen
Postoperative pain after laparoscopic cholecystectomy can be severe. Despite multimodal analgesia regimes, administration of high doses of opioids is often necessary. This can further lead to several adverse effects such as drowsiness and respiratory impairment as well as postoperative nausea and vomiting. This will hinder early mobilization and discharge of the patient from the day surgery setting and is suboptimal in an Early Recovery after Surgery setting. The ultrasound-guided Erector Spinae Plane (ESP) block is a novel truncal interfascial block technique providing analgesia of the thoracic or abdominal segmental innervation depending on the level of administration...
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/29796317/anesthetic-implications-for-cesarean-section-in-a-parturient-with-complex-congenital-cyanotic-heart-disease
#20
Huili Lim, Chuen Jye Yeoh, Jerry Tan, Harikrishnan Kothandan, May U S Mok
The discordance between increased physiological demand during pregnancy and congenital cardiac pathology of a parturient is a perilous threat to the maternal-fetal well-being. Early involvement of a multidisciplinary team is essential in improving peripartum morbidity and mortality. Designing the most appropriate anesthetic care will require a concerted effort, with inputs from the obstetricians, obstetric and cardiac anesthesiologists, cardiologists, neonatologists, and cardiothoracic surgeons. We report the multidisciplinary peripartum care and anesthetic management for cesarean section (CS) of a 28-year-old primigravida who has partially corrected transposition of the great arteries, atrial and ventricular septal defect, dextrocardia, right ventricle hypoplasia, and tricuspid atresia...
2018: Case Reports in Anesthesiology
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