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Case Reports in Anesthesiology

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https://www.readbyqxmd.com/read/29977620/glucose-management-during-insulinoma-resection-using-real-time-subcutaneous-continuous-glucose-monitoring
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
https://www.readbyqxmd.com/read/29686907/diagnosis-and-thrombolytic-management-of-massive-intraoperative-pulmonary-embolism-guided-by-point-of-care-transthoracic-echocardiography
#9
Roman Dudaryk, Julio Benitez Lopez, Jack Louro
Perioperative pulmonary embolism can go undetected until the sudden onset of cardiopulmonary collapse. Point of care echocardiography in such setting can narrow the differential diagnosis of precipitous instability and facilitate tailored, rather than empiric, therapy in the event of a massive pulmonary embolism. We describe the diagnosis and successful multidisciplinary management of intraoperative massive pulmonary embolism aided by both transthoracic and transesophageal echocardiography. Key aspects regarding the classification and treatment of pulmonary embolism are subsequently reviewed...
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/29670771/erector-spinae-plane-block-for-different-laparoscopic-abdominal-surgeries-case-series
#10
Serkan Tulgar, Onur Selvi, Mahmut Sertan Kapakli
The ultrasound guided erector spinae plane (ESP) block is a recent block described for various surgeries for postoperative analgesia. ESP block has effect on both visceral and somatic pain; therefore, its use in laparoscopic cholecystectomy and other abdominal surgeries can be advantageous. We describe successful ESP block application in three different cases for postoperative pain. Two patient were operated on using endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy and one patient was operated on using laparoscopic cholecystectomy together with the inguinal hernia operation...
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/29666709/anesthetic-considerations-for-an-adult-patient-with-freeman-sheldon-syndrome-undergoing-open-heart-surgery
#11
S Viehmeyer, P Gabriel, K Bauer, S Bauer, R Sodian, J N Hilberath
Freeman-Sheldon syndrome (FSS) or "whistling face" syndrome is a rare congenital disorder complicated by characteristic facial deformities and muscular contractures. We report on a 64-year-old male patient presenting for surgical replacement of his aortic valve and review the available literature on anesthetic considerations and perioperative management principles. FSS frequently poses a significant challenge to airway management and gaining vascular access. Moreover, these patients are reportedly at risk for developing malignant hyperthermia (MH) or neuroleptic malignant syndrome...
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/29623224/spinal-anaesthesia-for-cesarean-section-in-a-patient-with-vascular-type-ehlers-danlos-syndrome
#12
Jeffrey M Carness, Mark J Lenart
We report the administration of spinal anaesthesia for cesarean delivery in a parturient with vascular Ehlers-Danlos syndrome. Parturients who genetically inherit this disorder are at risk for significant morbidity and mortality. Risks during pregnancy include premature labor, uterine prolapse, and uterine rupture. Additionally, such laboring parturients are at increased risk of hemodynamic volatility, vascular stress, and severe postpartum hemorrhage. Instrumented delivery and cesarean delivery bring additional risks...
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/29607222/pulmonary-edema-and-diastolic-heart-failure-in-the-perioperative-period
#13
Galen Royce-Nagel, Kunal Karamchandani
Heart failure with preserved ejection fraction (HFPEF) is a diagnosis encountered with increasing frequency in the aging population. We present a case of postoperative pulmonary edema in 63-year-old male with HFPEF. This patient highlights the gap in risk stratification with respect to diastolic heart failure.
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/29607221/a-rare-central-venous-catheter-malposition-in-a-10-year-old-girl
#14
Ali Movafegh, Alireza Saliminia, Reza Atef-Yekta, Omid Azimaraghi
Central venous catheters (CVCs) are placed in operating rooms worldwide via different approaches. Like any other medical procedure, CVC placement can cause a variety of complications. We report the case of an unexpected malposition of a catheter in the right internal jugular vein, where it looped back on itself during placement and went upward into the right internal jugular vein. CVC line placement should always be viewed as a procedure that could become complicated, even in the hands of the most experienced operators...
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/29535876/ultrasound-guided-interscalene-catheter-complicated-by-persistent-phrenic-nerve-palsy
#15
Andrew T Koogler, Michael Kushelev
A 76-year-old male presented for reverse total shoulder arthroplasty (TSA) in the beach chair position. A preoperative interscalene nerve catheter was placed under direct ultrasound-guidance utilizing a posterior in-plane approach. On POD 2, the catheter was removed. Three weeks postoperatively, the patient reported worsening dyspnea with a subsequent chest X-ray demonstrating an elevated right hemidiaphragm. Pulmonary function testing revealed worsening deficit from presurgical values consistent with phrenic nerve palsy...
2018: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/29410922/unique-phrenic-nerve-sparing-regional-anesthetic-technique-for-pain-management-after-shoulder-surgery
#16
Jason K Panchamia, David A Olsen, Adam W Amundson
Background: Ipsilateral phrenic nerve blockade is a common adverse event after an interscalene brachial plexus block, which can result in respiratory deterioration in patients with preexisting pulmonary conditions. Diaphragm-sparing nerve block techniques are continuing to evolve, with the intention of providing satisfactory postoperative analgesia while minimizing hemidiaphragmatic paralysis after shoulder surgery. Case Report: We report the successful application of a combined ultrasound-guided infraclavicular brachial plexus block and suprascapular nerve block in a patient with a complicated pulmonary history undergoing a total shoulder replacement...
2017: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/29333298/inability-to-utilize-retrograde-cardioplegia-due-to-a-persistent-left-superior-vena-cava
#17
Rohesh J Fernando, Sean D Johnson
A persistent left superior vena cava is a congenital abnormality that affects a minority of the general population. While this finding is not hemodynamically significant in all patients, failure to recognize the altered anatomy in any of these patients can be consequential during procedures such as central venous catheter placement, pacemaker/defibrillator wire placement, and use of retrograde cardioplegia during cardiac surgery. We present a case of an intraoperative diagnosis of a persistent left superior vena cava that altered the original plan to arrest the heart using retrograde cardioplegia...
2017: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/29214081/a-rare-complication-of-a-tap-block-performed-after-caesarean-delivery
#18
Osman Nawazish Salaria, Murlikrishna Kannan, Bryan Kerner, Howard Goldman
The transversus abdominis plane block is a regional anesthesia technique that has become popular. Being a relatively simple procedure, the TAP block has an excellent safety profile and major complications are rare. We present a case of transient femoral nerve palsy occurring after a TAP block with involvement of the sacral plexus for a patient who had undergone a caesarean section.
2017: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/29181203/conducting-prolonged-general-anesthesia-without-intravenous-access-in-a-child-with-hypoplastic-left-heart-syndrome
#19
Phat T Dang, Binjon Sriratana
Children with chronic medical conditions often need multiple intravenous (IV) access instances during their hospitalizations, both peripheral and central. Obtaining a working IV in this patient population undergoing general anesthesia can be challenging. In our case report, we describe a method of administering general anesthesia in an infant with partially repaired hypoplastic left heart syndrome without IV access.
2017: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/29163991/an-undiagnosed-paraganglioma-in-a-58-year-old-female-who-underwent-tumor-resection
#20
William C Fox, Matthew Read, Richard E Moon, Eugene W Moretti, Brian J Colin
Paragangliomas and pheochromocytomas are rare neuroendocrine tumors that can have high morbidity and mortality if undiagnosed. Here we report a case of an undiagnosed paraganglioma in a 58-year-old female who underwent tumor resection. The patient became severely hypertensive intraoperatively with paroxysmal swings in blood pressure and then later became acutely hypotensive after tumor removal. She was managed in the surgical intensive care unit (SICU) postoperatively and discharged from the hospital without acute complications...
2017: Case Reports in Anesthesiology
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