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A & A Case Reports

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https://www.readbyqxmd.com/read/28767480/combined-selective-nerve-blockade-and-local-infiltration-analgesia-in-a-total-shoulder-arthroplasty-patient-with-chronic-pain-and-severe-restrictive-lung-disease-a-case-report
#1
Jason K Panchamia, David A Olsen, Joaquin Sanchez-Sotelo, Adam W Amundson
Interscalene brachial plexus block is considered the most complete postoperative analgesia after total shoulder arthroplasty. Interscalene brachial plexus block-induced ipsilateral hemidiaphragmatic paralysis may not be tolerated in patients with preexisting pulmonary disease. Selective distal nerve blocks avoid the risk of phrenic nerve block; however, they may provide incomplete analgesia to the glenohumeral joint. We report a case of combined selective suprascapular and axillary nerve blockade in combination with local infiltration analgesia in a patient with severe lung disease undergoing total shoulder arthroplasty...
December 15, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28767477/a-simple-and-effective-way-to-secure-a-laryngeal-mask-airway-in-place
#2
Shahram Shokohi, Mir Mousa Aghdashi
No abstract text is available yet for this article.
December 15, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28767476/atypical-neuroleptic-malignant-syndrome-diagnosis-and-proposal-for-an-expanded-treatment-algorithm-a-case-report
#3
Nicole M Schreiner, Samuel Windham, Andrew Barker
Neuroleptic malignant syndrome (NMS) in the absence of an elevated creatine kinase is atypical and more difficult to diagnose. We present a patient with NMS significant risk factors who developed atypical NMS 6 days after a liver transplant. Symptoms of hyperthermia, altered mental status, dyskinesia, and autonomic instability (hypertension and tachycardia) coincided with promethazine administration, with rapid progression to fulminant NMS with lead pipe rigidity after a single injection of intramuscular ziprasidone...
December 15, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28767475/exaggerated-oculocardiac-reflex-elicited-by-local-anesthetic-injection-of-an-empty-orbit-a-case-report
#4
David Nicholson, Andrea Kossler, Katie Topping, Creed M Stary
We report the first description of oculocardiac reflex elicited with injection of local anesthetic in an empty orbit, and highlight clinical indicators for patients that may be at risk for an exaggerated oculocardiac reflex. We describe a patient with prior head and eye trauma treated for anophthalmic socket reconstruction at an outpatient eye surgery center. Injection of local anesthetic into the empty orbit induced an extended sinus arrest. This exaggerated response was avoided in a subsequent surgery by pretreatment with high-dose anticholinergics...
December 15, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28767474/intraoperative-pulmonary-embolism-a-case-report-emphasizing-the-utility-of-electrocardiogram
#5
Josef Pleticha, Evan M Sutton
Pulmonary embolism (PE) is an important cause of perioperative morbidity and mortality. In patients with suspected PE, electrocardiogram (ECG) alone is thought to have a limited utility due to its low sensitivity and specificity. This case report describes a patient with intraoperative PE presenting with hypotension and hypoxemia for whom the ECG finding of SIQIIITIII was key in identifying acute cor pulmonale. The ECG was paramount in our decision to acquire computed tomography angiography to confirm the diagnosis, reinforcing its invaluable role in early detection of intraoperative PE...
December 15, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28767473/acquired-hemophilia-a-after-hepatic-yttrium-90-radioembolization-a-case-report
#6
Susanna Tribuzi, Alessia Naccarato, Lorella Pelagalli, Marco Covotta, Giulia Torregiani, Claudia Claroni, Ester Forastiere
Acquired hemophilia is a rare but potentially life-threatening bleeding disorder caused by the development of autoantibodies (inhibitors) directed against plasma coagulation factors, most frequently factor VIII. We report a case of a 65-year-old man with hepatocellular carcinoma who bled massively after a hepatic Yttrium-90 radioembolization procedure (Selective Internal Radiation Therapy with Yttrium-90 Resin Microspheres [SIRTex]). An acquired deficiency of factor VIII was diagnosed and successfully treated with recombinant activated factor VII and immunosuppression...
December 15, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28767472/intrathecal-migration-of-an-epidural-catheter-while-using-a-programmed-intermittent-epidural-bolus-technique-for-labor-analgesia-maintenance-a-case-report
#7
Francesca Betti, Brendan Carvalho, Edward T Riley
We describe a case of intrathecal migration of a wire-reinforced epidural catheter in a parturient who received epidural labor analgesia. Epidural analgesia was initiated with a combined-spinal epidural technique and maintained by programmed intermittent epidural boluses. Epidural catheter aspiration after insertion was negative for cerebrospinal fluid. The patient's response to the first four doses of local anesthetic was consistent with epidural drug delivery. After the fifth dose, she developed a complete lower extremity motor block, hypotension, and high sensory blockade...
December 15, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28767471/high-flow-nasal-oxygen-in-patient-with-obstructive-sleep-apnea-undergoing-awake-craniotomy-a-case-report
#8
Jaclyn W M Wong, Amy H S Kong, Sau Yee Lam, Peter Y M Woo
Patients with obstructive sleep apnea are frequently considered unsuitable candidates for awake craniotomy due to anticipated problems with oxygenation, ventilation, and a potentially difficult airway. At present, only a handful of such accounts exist in the literature. Our report describes the novel use of high-flow nasal oxygen therapy for a patient with moderate obstructive sleep apnea who underwent an awake craniotomy under deep sedation. The intraoperative application of high-flow nasal oxygen therapy achieved satisfactory oxygenation, maintained the partial carbon dioxide pressure within a reasonable range even during periods of deep sedation, permitted responsive patient monitoring during mapping, and provided excellent patient and surgeon satisfaction...
December 15, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28767470/loss-of-smell-and-taste-after-general-anesthesia-a-case-report
#9
Jason Joe Baker, Stina Öberg, Jacob Rosenberg
This case report describes a patient, who lost the ability to smell and taste after receiving a propofol-based general anesthesia for a laparoscopic inguinal hernia repair. Immediately after the procedure, the patient had anosmia (loss of smell), ageusia (loss of taste), and light dysphagia. Assessment by an otorhinolaryngologist and the results of a magnetic resonance imaging could not clarify the pathology behind these symptoms. Although there are several plausible explanations for the patient's anosmia and ageusia (eg, cerebral infarcts, nerve damage, chronic sinusitis), the most likely explanation is an uncommon adverse drug reaction to the anesthetic agents used during the procedure...
December 15, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28786851/oxymorphone-hydrochloride-extended-release-opana%C3%A2-associated-with-acute-kidney-injury-in-a-chronic-pain-patient-a-case-report
#10
Yan Yatsynovich, Dmitri Souza, Natallia Maroz
Oxymorphone hydrochloride extended-release (OPANA®) is an opioid prescribed for the treatment of moderate-to-severe chronic pain. Kidney injury related to its use has not previously been reported. We present a case of a chronic pain patient with underlying chronic renal insufficiency who developed superimposed acute kidney injury when his opioid analgesic was changed from morphine sulfate extended-release to OPANA. Electron microscopy of his renal tissue revealed lamellated podocytes typically seen with drug-induced phospholipidosis...
December 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28767481/when-faced-with-anesthetizing-an-infant-with-phace-syndrome-watch-out-for-an-airway-occluding-subglottic-hemangioma
#11
Monica S Shah, Susan T Verghese
No abstract text is available yet for this article.
December 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28767479/resistance-to-propofol-induction-in-a-patient-taking-modafinil-a-case-report
#12
Timothy N Harwood
After sedation with midazolam, induction of anesthesia with propofol was attempted in a patient taking modafinil. However, even after administration of a total of 6 mg/kg propofol IV, the patient continued to respond to tactile stimulation. Concurrently, the bispectral index was 72. Subsequent administration of low concentration sevoflurane by facemask induced an anesthetic depth that allowed unproblematic insertion of a laryngeal mask airway. Anesthesia for ophthalmologic surgery was maintained with sevoflurane...
December 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28767478/ultrasound-guided-serratus-plane-block-and-fast-track-tracheal-extubation-in-the-operating-room-for-thoracic-trauma-patients-a-case-report
#13
Pierfrancesco Fusco, Paolo Scimia, Stefano Di Carlo, Ambra Testa, Antonio Luciani, Emiliano Petrucci, Franco Marinangeli
Painful rib fractures may be a factor in trauma patients remaining intubated and being given postoperative mechanical ventilation after emergency surgery. Regional techniques could provide sufficient analgesia in these patients to enable weaning and extubation and thus prevent or minimize complications related to prolonged ventilatory support. We describe a trauma patient with multiple rib fractures requiring an emergency splenectomy for whom an ultrasound-guided serratus plane block provided good quality pain relief for his rib fractures and enabled fast-track extubation in the operating room...
December 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28727597/bilateral-continuous-erector-spinae-plane-block-contributes-to-effective-postoperative-analgesia-after-major-open-abdominal-surgery-a-case-report
#14
Carlos Eduardo Restrepo-Garces, Ki Jinn Chin, Patricia Suarez, Alejandro Diaz
The erector spinae plane (ESP) block is a regional anesthetic technique involving local anesthetic injection in a paraspinal plane deep to the erector spinae muscle. Originally described for thoracic analgesia when performed at the T5 transverse process, the ESP block can provide abdominal analgesia if performed at lower thoracic levels because the erector spinae muscles extend to the lumbar spine. A catheter inserted into this plane can extend analgesic duration and can be an alternative to epidural analgesia...
December 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28727596/intraoperative-acute-multivessel-coronary-vasospasm-in-cardiac-allograft-a-case-report
#15
Richard Sheu, Kathleen Berfield, Stephanie Jones, Jay Pal, G Burkhard Mackensen
We present a patient who developed acute intraoperative cardiac failure requiring open cardiac message immediately after uncomplicated heart transplantation. After successful resuscitation and establishment of extracorporeal membrane oxygenation, coronary angiography showed diffuse multivessel coronary vasospasm, which responded to intracoronary and IV administration of vasodilators. Cardiac function gradually improved and the patient was discharged home after a prolonged hospital course. Cardiac allograft dysfunction associated with coronary vasospasm immediately after heart transplantation has not previously been reported...
December 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28719384/anesthetic-management-of-an-infant-with-postnatally-diagnosed-tracheal-agenesis-undergoing-tracheal-reconstruction-a-case-report
#16
Brittany L Willer, Kayla G Bryan, Daiva E Parakininkas, Michael R Uhing, Susan R Staudt, Kathleen M Dominguez, Michael E McCormick, Michael E Mitchell, John C Densmore, Keith T Oldham, Richard J Berens
A term infant born cyanotic failed multiple intubation attempts and tracheostomy placement. After esophageal intubation resulted in the ability to ventilate, he was presumed to have tracheal agenesis and distal bronchoesophageal fistula. He was transferred to our institution where he was diagnosed with Floyd Type II tracheal agenesis. He underwent staged tracheal reconstruction. He was discharged to home at 4 months of age with a tracheostomy collar, cervical spit fistula, and gastrostomy tube. He represents the sole survivor-to-discharge of tracheal agenesis in the United States...
December 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28708629/successful-assessment-of-vocal-cord-palsy-before-tracheal-extubation-by-laryngeal-ultrasonography-in-a-patient-after-esophageal-surgery-a-case-report
#17
Natsuhiro Yamamoto, Yoshikazu Yamaguchi, Takeshi Nomura, Osamu Yamaguchi, Takahisa Goto
Laryngeal ultrasonography has mainly been performed after tracheal extubation. However, improvements in ultrasound technology now allow assessment of vocal cord function even under conditions of endotracheal intubation. We report herein the use of laryngeal ultrasonography in an endotracheally intubated patient after esophagectomy, which allowed us to make the presumptive diagnosis of bilateral recurrent nerve palsy before tracheal extubation. Our experience suggests that laryngeal ultrasonography may be useful in assessing vocal cord function even in endotracheally intubated patients, although the indications and efficacy remain to be determined...
December 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28697034/iatrogenic-endotracheal-tube-obstruction-by-tegaderm
#18
Lance S Patak
No abstract text is available yet for this article.
December 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28697033/ventricular-perforation-during-open-surgical-balloon-expandable-mitral-valve-replacement-a-case-report
#19
Yousef M Hamdeh, Jordan E Goldhammer, Nicholas J Ruggiero, John W Entwistle
A 79-year-old woman with severe mitral annular calcification was scheduled for mitral valve replacement. A SAPIEN 3 valve was implanted in mitral position using an open surgical approach. Immediately after cardiopulmonary bypass, bleeding from an unidentified source was encountered. Cardiopulmonary bypass was emergently resumed and a laceration of the left ventricular apex due to the valve delivery system was detected. Risk factors specific to the open surgical approach include a decompressed ventricle, decreased annulus to apical distance, and the absence of continuous fluoroscopic and echocardiographic imaging...
November 15, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28697032/genicular-radiofrequency-ablation-for-treatment-of-post-total-knee-arthroplasty-posterior-thigh-pain-a-case-report
#20
Lauren N Sylvester, Johnathan H Goree
We present a case of a 68-year-old woman with 6 months of chronic unilateral posterior thigh pain after a total knee arthroplasty. The patient's pain was refractory to various treatments. After appropriate diagnostic tests, a genicular nerve block and subsequent radiofrequency ablation were performed. These procedures provided substantial pain relief of her thigh pain at 3 months follow-up.
November 15, 2017: A & A Case Reports
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