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Case Reports in Anesthesiology

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https://www.readbyqxmd.com/read/29686907/diagnosis-and-thrombolytic-management-of-massive-intraoperative-pulmonary-embolism-guided-by-point-of-care-transthoracic-echocardiography
#1
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
#2
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
#3
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
#4
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
#5
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
#6
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
#7
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
#8
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
#9
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
#10
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
#11
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
#12
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
#13
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
#14
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
#15
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
#16
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
#17
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
#18
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
#19
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
#20
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
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