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Case Reports in Anesthesiology

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https://www.readbyqxmd.com/read/27900224/perioperative-severe-hypotension-in-a-patient-with-multiple-endocrine-neoplasia-type-iib-and-bilateral-adrenalectomies-time-to-review-the-evidence-for-stress-dose-steroids
#1
Jens Tan, Acsa Zavala, Katherine B Hagan, Antoinette Van Meter, Uduak Ursula Williams, Wei Zhang, Pascal Owusu-Agyemang
Multiple endocrine neoplasia type IIb (MEN IIb) is an endocrine disorder which can manifest with tumors such as pheochromocytomas and neuromas. We present the case of a patient with MEN IIb, after bilateral adrenalectomies, on maintenance steroid replacement, who underwent a neuroma resection and developed severe hypotension. There is persistent controversy regarding the general administration of perioperative "stress dose" steroids for patients with adrenal insufficiency. While the most recent literature suggests that stress dose steroids are unnecessary for secondary adrenal insufficiency, the rarer form of primary adrenal insufficiency always requires supplemental steroids, specifically hydrocortisone, when undergoing surgical procedures...
2016: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/27895942/an-unusual-lacerated-tracheal-tube-during-le-fort-surgery-literature-review-and-case-report
#2
Preeta George, John E Fiadjoe, Allan F Simpao
Maxillofacial surgeries can present unique anesthetic challenges due to potentially complex anatomy and the close proximity of the patient's airway to the surgical field. Damage to the tracheal tube (TT) during maxillofacial surgery may lead to significant airway compromise. We report the management of a patient with a partially severed TT during Le Fort surgery for midfacial hypoplasia and management strategies based on peer-reviewed literature. This case illustrates the clinical clues associated with a damaged TT and explores the challenges of managing this potentially catastrophic issue...
2016: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/27872765/cardiac-arrest-after-local-anaesthetic-toxicity-in-a-paediatric-patient
#3
Liana Maria Torres de Araújo Azi, Diego Grimaldi Figueroa, Ana Amélia Souza Simas
We report a case of a paediatric patient undergoing urological procedure in which a possible inadvertent intravascular or intraosseous injection of bupivacaine with adrenaline in usual doses caused subsequent cardiac arrest, completely reversed after administration of 20% intravenous lipid emulsion. Early diagnosis of local anaesthetics toxicity and adequate cardiovascular resuscitation manoeuvres contribute to the favourable outcome.
2016: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/27822391/ultrasound-guided-genicular-nerve-thermal-radiofrequency-ablation-for-chronic-knee-pain
#4
Joshua Wong, Nicholas Bremer, Paul D Weyker, Christopher A J Webb
Osteoarthritis (OA) of the knee is one of the most common joint diseases affecting adults in the United States. For elderly patients with multiple medical comorbidities who do not wish to undergo total knee arthroplasty (TKA), lifestyle modification, pharmacologic management, and injections are the mainstay of therapy. Previously, pain management interventions were limited to intra-articular joint injections and viscosupplementation with hyaluronic acid. Fluoroscopic-guided techniques for radiofrequency ablation (RFA) of the genicular nerves have been previously described and a recent cadaveric study suggests that ultrasound-guided genicular nerve blocks can be performed accurately...
2016: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/27803817/ultrasound-guided-femoral-and-sciatic-nerve-blocks-for-repair-of-tibia-and-fibula-fractures-in-a-bennett-s-wallaby-macropus-rufogriseus
#5
Paolo Monticelli, Luis Campoy, Chiara Adami
Locoregional anesthetic techniques may be a very useful tool for the anesthetic management of wallabies with injuries of the pelvic limbs and may help to prevent capture myopathies resulting from stress and systemic opioids' administration. This report describes the use of ultrasound-guided femoral and sciatic nerve blocks in Bennett's wallaby (Macropus rufogriseus) referred for orthopaedic surgery. Ultrasound-guided femoral and sciatic nerve blocks were attempted at the femoral triangle and proximal thigh level, respectively...
2016: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/27721997/an-unexpected-airway-complication-in-a-male-patient-with-goltz-syndrome
#6
Sadie Smith, Kavita Gadhok, Dmitri Guvakov
Goltz syndrome, also known as focal dermal hypoplasia, is a rare X-linked dominant multisystem syndrome presenting with cutaneous, skeletal, dental ocular, central nervous system and soft tissue abnormalities. This case report discusses an adult male patient with Goltz syndrome that was noted to have large, papillomatous, hypopharyngeal lesions upon induction of general anesthesia. We highlight challenges with airway management intraoperatively and postoperatively in patients with Goltz syndrome. Our aim is to increase awareness of the potential airway complications associated with this genetic disorder and to provide suggestions for optimal perioperative management for patients afflicted with Goltz syndrome...
2016: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/27672454/bronchoesophageal-fistula-stenting-using-high-frequency-jet-ventilation-and-underwater-seal-gastrostomy-tube-drainage
#7
Nitish Fokeerah, Xinwei Liu, Yonggang Hao, Lihua Peng
Managing a patient scheduled for bronchoesophageal fistula repair is challenging for the anesthetist. If appropriate ventilation strategy is not employed, serious complications such as hypoxemia, gastric distension, and pulmonary aspiration can occur. We present the case of a 62-year-old man with a bronchoesophageal fistula in the left main stem bronchus requiring the insertion of a Y-shaped tracheobronchial stent through a rigid bronchoscope, under general anesthesia. We successfully managed this intervention and herein report this case to demonstrate the effectiveness of underwater seal gastrostomy tube drainage used in conjunction with high-frequency jet ventilation during bronchoesophageal fistula stenting...
2016: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/27668095/epidural-analgesia-with-ropivacaine-during-labour-in-a-patient-with-a-scn5a-gene-mutation
#8
A L M J van der Knijff-van Dortmont, M Dirckx, J J Duvekot, J W Roos-Hesselink, A Gonzalez Candel, C D van der Marel, G P Scoones, V F R Adriaens, I J J Dons-Sinke
SCN5A gene mutations can lead to ion channel defects which can cause cardiac conduction disturbances. In the presence of specific ECG characteristics, this mutation is called Brugada syndrome. Many drugs are associated with adverse events, making anesthesia in patients with SCN5A gene mutations or Brugada syndrome challenging. In this case report, we describe a pregnant patient with this mutation who received epidural analgesia using low dose ropivacaine and sufentanil during labour.
2016: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/27651956/epidural-anesthesia-complicated-by-subdural-hygromas-and-a-subdural-hematoma
#9
Christine Vien, Paul Marovic, Brendan Ingram
Inadvertent dural puncture during epidural anesthesia leads to intracranial hypotension, which if left unnoticed can cause life-threatening subdural hematomas or cerebellar tonsillar herniation. The highly variable presentation of intracranial hypotension hinders timely diagnosis and treatment. We present the case of a young laboring adult female, who developed subdural hygromas and a subdural hematoma following unintentional dural puncture during initiation of epidural anesthesia.
2016: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/27648310/anesthetic-management-of-a-surgical-patient-with-chronic-renal-tubular-acidosis-complicated-by-subclinical-hypothyroidism
#10
Hiroe Yoshioka, Haruyuki Yamazaki, Rie Yasumura, Kosuke Wada, Yoshiro Kobayashi
A 53-year-old man with chronic renal tubular acidosis and subclinical hypothyroidism underwent lower leg amputation surgery under general anesthesia. Perioperative acid-base management in such patients poses many difficulties because both pathophysiologies have the potential to complicate the interpretation of capnometry and arterial blood gas analysis data; inappropriate correction of chronic metabolic acidosis may lead to postoperative respiratory deterioration. We discuss the management of perioperative acidosis in order to achieve successful weaning from mechanical ventilation and promise a complete recovery from anesthesia...
2016: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/27559484/a-rare-case-of-c2-sensory-blockade-with-preserved-phrenic-nerve-function-in-an-obstetric-patient
#11
John C Coffman, Kasey Fiorini, Meghan Cook, Robert H Small
High neuraxial blockade is a serious complication in obstetric patients and requires prompt recognition and management in order to optimize patient outcomes. In cases of high neuroblockade, patients may present with significant hypotension, dyspnea, agitation, difficulty speaking or inability to speak, or even loss of consciousness. We report the unusual presentation of an obstetric patient that remained hemodynamically stable and had the preserved ability to initiate breaths despite sensory blockade up to C2...
2016: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/27340571/the-auscultation-of-a-carbon-dioxide-embolization-event-during-endoscopic-vein-harvest
#12
Erik Strauss, Bradley Taylor, Michael Mazzeffi, Kenichi Tanaka, Patrick Odonkor
Endoscopic vein harvest in preparation for coronary artery bypass surgery has become a preferred method of procuring saphenous vein. Several case reports have documented carbon dioxide (CO2) embolization with this procedure as well as CO2 embolization during other laparoscopic surgeries (Markar et al., 2010). Although uncommon, the potential for CO2 entrainment through an open vein or through absorption by vascular structures exists and should be recognized (Lin et al., 2003). We report a case of CO2 embolization during EVH for a 77-year-old patient who underwent CABG that was identified early by the cardiac surgeon through the indirect auscultation of a mill-wheel murmur after the pericardium was opened...
2016: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/27298743/sedation-monitoring-and-management-during-percutaneous-endoscopic-lumbar-discectomy
#13
Menekse Oksar, Tulin Gumus, Orhan Kanbak
Percutaneous endoscopic laser discectomy (PELD) is a painful intervention that requires deep sedation and analgesia. However, sedation should be light at some point because cooperation by the patient during the procedure is required for successful surgical treatment. Light sedation poses a problem for endotracheal intubation, while patients placed in the prone position during percutaneous endoscopic discectomy pose a problem for airway management. Therefore, under these conditions, sedation should be not deeper than required...
2016: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/27200193/thoracic-paravertebral-block-multimodal-analgesia-and-monitored-anesthesia-care-for-breast-cancer-surgery-in-primary-lateral-sclerosis
#14
Anis Dizdarevic, Anthony Fernandes
Objective. Primary lateral sclerosis (PLS) is a rare idiopathic neurodegenerative disorder affecting upper motor neurons and characterized by spasticity, muscle weakness, and bulbar involvement. It can sometimes mimic early stage of more common and fatal amyotrophic lateral sclerosis (ALS). Surgical patients with a history of neurodegenerative disorders, including PLS, may be at increased risk for general anesthesia related ventilatory depression and postoperative respiratory complications, abnormal response to muscle relaxants, and sensitivity to opioids, sedatives, and local anesthetics...
2016: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/27069694/anesthesiological-management-of-a-patient-with-williams-syndrome-undergoing-spine-surgery
#15
Federico Boncagni, Luca Pecora, Vasco Durazzi, Francesco Ventrella
Williams Syndrome (WS) is a complex neurodevelopmental disorder associated with a mutation on chromosome 7. Patients with WS usually display dysmorphic facial and musculoskeletal features, congenital heart diseases, metabolic disturbances and cognitive impairment. Structural cardiovascular abnormalities are present in the majority of the children and may provide a substrate for perioperative Sudden Cardiac Death, as presented by several reports, something that creates a great challenge to the anesthetic conduct...
2016: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/27018074/use-of-an-esophageal-heat-exchanger-to-maintain-core-temperature-during-burn-excisions-and-to-attenuate-pyrexia-on-the-burns-intensive-care-unit
#16
David Williams, Gordon Leslie, Dimitrios Kyriazis, Benjamin O'Donovan, Joanne Bowes, John Dingley
Introduction. Burns patients are vulnerable to hyperthermia due to sepsis and SIRS and to hypothermia due to heat loss during excision surgery. Both states are associated with increased morbidity and mortality. We describe the first use of a novel esophageal heat exchange device in combination with a heater/cooler unit to manage perioperative hypothermia and postoperative pyrexia. Material and Methods. The device was used in three patients with full thickness burns of 51%, 49%, and 45% body surface area to reduce perioperative hypothermia during surgeries of >6 h duration and subsequently to control hyperthermia in one of the patients who developed pyrexia of 40°C on the 22nd postoperative day due to E...
2016: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/26989518/management-of-anesthesia-under-extracorporeal-cardiopulmonary-support-in-an-infant-with-severe-subglottic-stenosis
#17
Rie Soeda, Fumika Taniguchi, Maiko Sawada, Saeko Hamaoka, Masayuki Shibasaki, Yasufumi Nakajima, Satoru Hashimoto, Teiji Sawa, Yoshinobu Nakayama
A 4-month-old female infant who weighed 3.57 kg with severe subglottic stenosis underwent tracheostomy under extracorporeal cardiopulmonary support. First, we set up extracorporeal cardiopulmonary support to the infant and then successfully intubated an endotracheal tube with a 2.5 mm inner diameter before tracheostomy by otolaryngologists. Extracorporeal cardiopulmonary support is an alternative for maintenance of oxygenation in difficult airway management in infants.
2016: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/26981288/is-it-possible-to-maintain-consciousness-and-spontaneous-ventilation-with-chest-compression-in-the-early-phase-of-cardiac-arrest
#18
Menekse Oksar, Selim Turhanoglu
Chest compression is important in cardiopulmonary resuscitation. However, life support algorithms do not specify when chest compression should be initiated in patients with persistent spontaneous normal breathing in the early phase after cardiac arrest. Here we describe the case of a 69-year-old man who underwent femoral bypass surgery and was extubated at the end of the procedure. After extubation, the patient's breathing pattern and respiratory rate were normal. The patient subsequently developed ventricular fibrillation, evident on two monitors...
2016: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/26904304/workup-and-management-of-persistent-neuralgia-following-nerve-block
#19
Paul David Weyker, Christopher Allen-John Webb, Thoha M Pham
Neurological injuries following peripheral nerve blocks are a relatively rare yet potentially devastating complication depending on the type of lesion, affected extremity, and duration of symptoms. Medical management continues to be the treatment modality of choice with multimodal nonopioid analgesics as the cornerstone of this therapy. We report the case of a 28-year-old man who developed a clinical common peroneal and lateral sural cutaneous neuropathy following an uncomplicated popliteal sciatic nerve block...
2016: Case Reports in Anesthesiology
https://www.readbyqxmd.com/read/26904303/complex-perioperative-decision-making-liver-resection-in-a-patient-with-extensive-superior-vena-cava-right-atrial-thrombus-and-superior-vena-cava-syndrome
#20
Benjamin Kloesel, Robert W Lekowski
The perioperative management of patients suffering from extensive superior vena cava (SVC) thrombus complicated by SVC syndrome presents unique challenges. The anesthesiologist needs to be prepared for possible thrombus dislodgement resulting in pulmonary embolism and also has to assess the need for fluid resuscitation given the dangers of massive intravenous fluid application via the upper extremities. We present our perioperative approach in management of a patient scheduled for right hepatectomy who was previously diagnosed with extensive SVC and right atrial (RA) thrombus complicated by SVC syndrome...
2016: Case Reports in Anesthesiology
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