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Case Reports in Anesthesiology

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https://www.readbyqxmd.com/read/29214081/a-rare-complication-of-a-tap-block-performed-after-caesarean-delivery
#1
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
#2
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
#3
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
https://www.readbyqxmd.com/read/29147587/dexmedetomidine-as-part-of-a-multimodal-analgesic-treatment-regimen-for-opioid-induced-hyperalgesia-in-a-patient-with-significant-opioid-tolerance
#4
Richard K Patch Iii, Jason S Eldrige, Susan M Moeschler, Matthew J Pingree
Acute postoperative pain in patients with opioid tolerance creates a significant management challenge for anesthesiologists and pain medicine physicians. A multimodal approach is key; however other factors can complicate management such as opioid induced hyperalgesia. We present the case of a patient on large amounts of intrathecal opioids for chronic pain syndrome with opioid induced hyperalgesia after an exploratory laparotomy. Dexmedetomidine was utilized successfully as part of a controlled multimodal analgesic plan and should be a consideration for opioid tolerant patients experiencing opioid induced hyperalgesia...
2017: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/28798877/previously-undiagnosed-spinal-and-bulbar-muscular-atrophy-as-a-cause-of-airway-obstruction-after-robot-assisted-laparoscopic-prostatectomy
#5
Miyuki Niki, Taihei Tachikawa, Yuka Sano, Hiroki Miyawaki, Aisa Matoi, Yukari Okano, Nobutaka Kariya, Tsuneo Tatara, Munetaka Hirose
BACKGROUND: Preoperative vocal cord paralysis is a risk factor for postoperative respiratory distress following extubation after general anesthesia. We present an unusual case where a geriatric patient developed airway obstruction after robot-assisted laparoscopic prostatectomy. CASE PRESENTATION: A 67-year-old male, who had suffered from left vocal cord paralysis of unknown etiology, was scheduled for robot-assisted laparoscopic prostatectomy (RALP). General anesthesia was performed without any problems...
2017: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/28713597/ketamine-use-for-successful-resolution-of-post-ercp-acute-pancreatitis-abdominal-pain
#6
Suneel M Agerwala, Divya Sundarapandiyan, Garret Weber
We report a case in which a patient with intractable pain secondary to post-endoscopic retrograde cholangiopancreatography (ERCP) acute pancreatitis is successfully treated with a subanesthetic ketamine infusion. Shortly after ERCP, the patient reported severe stabbing epigastric pain. She exhibited voluntary guarding and tenderness without distension. Amylase and lipase levels were elevated. Pain persisted for hours despite hydromorphone PCA, hydromorphone boluses, fentanyl boluses, and postprocedure anxiolytics...
2017: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/28713596/discharge-against-medical-advice-in-surgical-patients-with-posttraumatic-stress-disorder-a-case-report-series-illustrating-unique-challenges
#7
Marek Brzezinski, Maren Gregersen, Luiz Gustavo Schuch, Ricarda Sawatzki, Joy W Chen, Grant Gauger, Jasleen Kukreja, Brian Cason
Discharge against medical advice (DAMA) can have detrimental effects on patient outcomes. Recently, the diagnosis of posttraumatic stress disorder (PTSD) has been linked with DAMA in the mental health setting. However, PTSD as a risk factor for DAMA in surgical patients has not received much consideration, although such patients may be at risk for triggering or amplification of PTSD symptoms perioperatively. We present the first case report series of three surgical patients with PTSD who left the hospital AMA...
2017: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/28638663/acute-abdominal-compartment-syndrome-following-extraperitoneal-bladder-perforation
#8
Ana Licina
Extraperitoneal bladder perforation is a known complication of a commonly performed rigid cystoscopy. If unrecognized, this complication can lead to continuous intra-abdominal fluid leakage with consequent organ function impairment and symptoms. This is the first case report in literature of a transurethral bladder perforation causing an acute abdominal compartment syndrome, which was subsequently managed conservatively with supportive management only. Case Presentation. We describe a clinical course of a 73-year-old Caucasian female whose initial acute presentation involved urinary symptoms...
2017: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/28523194/pneumomediastinum-and-bilateral-pneumothoraces-causing-respiratory-failure-after-thyroid-surgery
#9
Michael Koeppen, Benjamin Scott, Joseph Morabito, Matthew Fiegel, Tobias Eckle
We report the first case of severe respiratory failure after thyroid surgery requiring venovenous extracorporeal membrane oxygenation (vvECMO). The patient was a 41-year-old woman with metastatic thyroid cancer. She underwent thyroidectomy, including left lateral and bilateral central neck dissection. During surgery, the patient developed pneumomediastinum with bilateral pneumothoraces. Despite early treatment with bilateral chest tubes and no evidence of a tracheal perforation, the patient developed severe respiratory failure after extubation on the intensive care unit...
2017: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/28465842/postoperative-airway-obstruction-by-a-bone-fragment
#10
Patrick Schober, K Hakki Karagozoglu, Stephan A Loer, Lothar A Schwarte
Postoperative airway obstructions are potentially life-threatening complications. These obstructions may be classified as functional (sagging tongue, laryngospasm, or bronchospasm), pathoanatomical (airway swelling or hematoma within the airways), or foreign body-related. Various cases of airway obstruction by foreign bodies have previously been reported, for example, by broken teeth or damaged airway instruments. Here we present the exceptional case of a postoperative airway obstruction due to a large fragment of the patient's maxillary bone, left accidentally in situ after transoral surgical tumor resection...
2017: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/28392946/management-of-residual-neuromuscular-blockade-recovery-age-old-problem-with-a-new-solution
#11
Michael S Green, Archana Gundigi Venkatesh, Ranjani Venkataramani
Neostigmine has been traditionally used as the agent of choice to reverse Neuromuscular Blockade (NMB) after muscle paralysis during general anesthesia. However, the use of neostigmine has not been without untoward events. Sugammadex is a novel drug that selectively binds to aminosteroid nondepolarizing muscle relaxants and reverses even a deep level of NMB. Controversy exists regarding the optimal dose of sugammadex that is effective in reversing the NMB after the incomplete reversal with neostigmine and glycopyrrolate...
2017: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/28392945/pitfalls-in-interventional-pain-medicine-hyponatremia-after-ddavp-for-a-patient-with-von-willebrand-disease-undergoing-an-epidural-steroid-injection
#12
Talal W Khan, Abdulraheem Yacoub
Desmopressin (DDAVP), a synthetic analog of vasopressin, has been used in patients with von Willebrand disease (VWD), mild hemophilia A, and platelet dysfunction to reduce the risk of bleeding associated with surgical and interventional procedures. We report the case of a patient with VWD presenting with a bulging disc and radicular pain that underwent transforaminal epidural steroid injections. Her course was complicated with the interval development of headaches and dizziness symptomatic of moderate hyponatremia, likely due to excessive fluid intake...
2017: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/28348896/effect-of-arm-positioning-on-entrapment-of-infraclavicular-nerve-block-catheter
#13
Eric Kamenetsky, Rahul Reddy, Mark C Kendall, Antoun Nader, Jessica J Weeks
Continuous brachial plexus nerve block catheters are commonly inserted for postoperative analgesia after upper extremity surgery. Modifications of the insertion technique have been described to improve the safety of placing an infraclavicular brachial plexus catheter. Rarely, these catheters may become damaged or entrapped, complicating their removal. We describe a case of infraclavicular brachial plexus catheter entrapment related to differences in arm positioning during catheter placement and removal. Written authorization to obtain, use, and disclose information and images was obtained from the patient...
2017: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/28348895/in-flight-hypoxemia-in-a-tracheostomy-dependent-infant
#14
Jason Quevreaux, Christopher Cropsey
Millions of passengers board commercial flights every year. Healthcare providers are often called upon to treat other passengers during in-flight emergencies. The case presented involves an anesthesia resident treating a tracheostomy-dependent infant who developed hypoxemia on a domestic flight. The patient had an underlying congenital muscular disorder and was mechanically ventilated while at altitude. Although pressurized, cabin barometric pressure while at altitude is less than at sea level. Due to this environment patients with underlying pulmonary or cardiac pathology might not be able to tolerate commercial flight...
2017: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/28326200/the-anaesthesiologist-and-palliative-care-in-a-newborn-with-the-adam-sequence
#15
Alberto Vieira Pantoja, Maria Emília Gonçalves Estevez, Bruno Lima Pessoa, Fernando de Paiva Araújo, Bruno Mendonça Barcellos, Ciro Augusto Floriani, Marco Antonio Cardoso de Resende
Reports focusing on biomedical principlism and the role of anaesthesiologists in palliative care are rare. We present the case of a newborn with multiple craniofacial anomalies and a diagnosis of ADAM "sequence," in which surgical removal of placental adhesions to the dura mater and the correction of meningocele was not indicated due to the very short life expectancy. After 48 hours, the odor from the placenta indicted a necrotic process, which prevented the parents from being close to the child and increased his isolation...
2017: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/28316843/anesthetic-considerations-in-a-patient-with-myotonic-dystrophy-for-hip-labral-repair
#16
Ramon Go, David Wang, Danielle Ludwin
Myotonic Dystrophy (DM) affects multiple organ systems. Disorders such as hyperthyroidism, progressive musculoskeletal weakness, cardiac dysrhythmias, hypoventilation, and cognitive-behavioral disorders may be present in these patients. Thorough preoperative assessment and anesthetic planning are required to minimize the risk of anesthetic complications. Patients with DM can exhibit exquisite sensitivity to sedatives, neuromuscular blocking agents, and volatile anesthetics, resulting in potential postoperative complications...
2017: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/28197344/from-bad-to-worse-paraganglioma-diagnosis-during-induction-of-labor-for-coexisting-preeclampsia
#17
Sasima Dusitkasem, Blair H Herndon, Dalton Paluzzi, Joseph Kuhn, Robert H Small, John C Coffman
Pheochromocytomas and extra-adrenal paragangliomas are catecholamine-secreting tumors that rarely occur in pregnancy. The diagnosis of these tumors in pregnancy can be challenging given that many of the signs and symptoms are commonly attributed to preeclampsia or other more common diagnoses. Early diagnosis and appropriate management are essential in optimizing maternal and fetal outcomes. We report a rare case of a catecholamine-secreting tumor in which diagnosis occurring at the time labor was being induced for concomitant preeclampsia with severe features...
2017: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/28163936/surdity-in-the-or-an-unusual-case-of-brainstem-anesthesia
#18
Howard D Palte, Don P Hoa, Aldo Pavon Canseco
Brainstem anesthesia is a potentially life-threatening complication of regional ophthalmic anesthesia. This case report chronicles an unusual presentation of brainstem anesthesia following an eye block. The unique features of this case were the presenting symptoms of deafness and slurred speech in the absence of loss of consciousness, respiratory depression, or contralateral ophthalmoplegia. This report underscores two key points: first, the importance of ongoing patient monitoring after performance of an eye block; second, the exigency of supportive therapy in suspected cases of brainstem anesthesia...
2017: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/28149652/bilateral-intra-articular-radiofrequency-ablation-for-cervicogenic-headache
#19
Charles A Odonkor, Teresa Tang, David Taftian, Akhil Chhatre
Introduction. Cervicogenic headache is characterized by unilateral neck or face pain referred from various structures such as the cervical joints and intervertebral disks. A recent study of patients with cervical pain showed significant pain relief after cervical medial branch neurotomy but excluded patients with C1-2 joint pain. It remains unclear whether targeting this joint has potential for symptomatic relief. To address this issue, we present a case report of C1-2 joint ablation with positive outcomes...
2017: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/28116174/orotracheal-intubation-using-the-retromolar-space-a-reliable-alternative-intubation-approach-to-prevent-dental-injury
#20
Linh T Nguyen, Sudip D Thakar, Angela T Truong, Dam-Thuy Truong
Despite recent advances in airway management, perianesthetic dental injury remains one of the most common anesthesia-related adverse events and cause for malpractice litigation against anesthesia providers. Recommended precautions for prevention of dental damage may not always be effective because these techniques involve contact and pressure exerted on vulnerable teeth. We describe a novel approach using the retromolar space to insert a flexible fiberscope for tracheal tube placement as a reliable method to achieve atraumatic tracheal intubation...
2016: Case Reports in Anesthesiology
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