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A & A Case Reports

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https://www.readbyqxmd.com/read/29045243/use-of-ketamine-in-a-multimodal-analgesia-setting-for-rapid-opioid-tapering-in-a-profoundly-opioid-tolerant-patient-a-case-report
#1
Elise M Strickler, Eric S Schwenk, Mitchell J Cohen, Eugene R Viscusi
Opioids are frequently used for the treatment of chronic pain, and patients taking high doses are at increased risk of complications and adverse opioid-related events. Ketamine is appealing as an opioid adjunct because of its lack of respiratory depression and potential prevention of hyperalgesia and central sensitization. We present a case in which a ketamine infusion was utilized over a 7-day period to provide rapid taper of a daily dose of 400 mg of morphine equivalents to less than one-third of that dose on discharge with unchanged pain levels and no symptoms of opioid withdrawal...
October 17, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/29045242/roles-of-the-microsurgeon-and-anesthesiologist-in-the-treatment-of-neonatal-upper-extremity-arterial-thrombosis-a-case-report
#2
Alexandra M Keane, Katherine B Santosa, Sonia M Shahrawat, Alison K Snyder-Warwick
We present a rare case of a newborn with spontaneous, noniatrogenic arterial thromboembolism in the right brachial artery and accompanying ischemic changes to the right upper extremity, who was successfully treated with microsurgical intervention and ultrasound-guided infraclavicular brachial plexus block with a continuous infusion of ropivacaine for 48 hours. This case report highlights the emerging role of both the microsurgeon and anesthesiologist in management of spontaneous neonatal arterial thromboembolism...
October 17, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/29045241/taking-assent-to-new-heights-a-case-report-on-do-not-resuscitate-status-in-pediatric-palliative-care-procedures
#3
Heather A Ballard, Santhanam Suresh
Dying adolescents presenting for palliative procedures have complicated developmental and ethical issues, especially when reconsidering do-not-resuscitate orders. Though the American Academy of Pediatrics has guidelines, there is limited information in the literature on how to take care of these patients. We describe the case of a 14-year-old patient presenting to the interventional radiology suite for management of superior vena cava syndrome. The patient's goals of treatment were elucidated through a comprehensive care team consisting of the procedural and oncology teams...
October 17, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/29028640/coronary-sinus-catheter-induced-heart-block-during-aortic-valve-replacement-a-case-report
#4
Aaron B Dahl, Teresa Murray-Torres, Daniel A Emmert
Conduction abnormalities after cardiac surgery are common as is spontaneous resolution of these abnormalities. However, 1%-3% of patients will require placement of a permanent pacemaker. Patients with preexisting conduction abnormalities, undergoing reoperation, preexisting pulmonary hypertension and undergoing mitral or aortic valve operations are at a higher risk for requiring a permanent pacemaker. We present the first case described in the literature of a patient with a preexisting left bundle branch block, and heart failure with a reduced left ventricular ejection fraction of 25% who developed complete heart block after placement of a coronary sinus catheter...
October 12, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/29028639/implications-of-mitochondrial-dysfunction-for-the-anesthetic-and-perioperative-management-a-case-report-of-spinal-fusion-genetic-confusion-and-a-patient-s-perspective
#5
Linda S Aglio, Brian T Lockhart, Jeantine E Lunshof, Christoph S Nabzdyk
We describe a patient's personal struggle with a symptom complex consisting of profound muscle weakness requiring pyridostigmine, and metabolic abnormalities suggestive of mitochondrial disease. This included a profound sensitivity to opioids, which in the past caused severe respiratory depression during a prior hospital admission. Interestingly, the patient herself is a professor of ethics in genomic sciences, and she and her medical team thus far have not been able to formally diagnose her with mitochondrial disease...
October 12, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/29028638/malignant-hyperthermia-versus-thyroid-storm-in-a-patient-with-symptomatic-graves-disease-a-case-report
#6
Sara M Strowd, Michael B Majewski, Jennifer Asteris
Malignant hyperthermia and thyroid storm are intraoperative emergencies with overlapping symptoms but different treatment protocols. We faced this diagnostic dilemma in a 25-year-old patient with symptomatic hyperthyroidism, elevated free T3 and free T4, and low thyroid-stimulating hormone from Graves disease despite treatment with propranolol 80 mg daily and methimazole 40 mg every 8 hours. During thyroidectomy, he developed hyperthermia and hypercarbia without tachycardia. When the rate of rise of PaCO2 and temperature accelerated, we treated the patient for malignant hyperthermia, a diagnosis subsequently confirmed by genetic testing...
October 12, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/29028637/hemorrhagic-shock-after-epicardial-pacing-wire-removal-a-case-report
#7
Paul A Warner, Lindsay L Warner, Alberto Pochettino, Tuhin K Roy
Epicardial pacing wires are routinely used to avoid hemodynamic instability due to perioperative arrhythmias after cardiac surgery. In rare cases, pacing wires themselves can be associated with potentially life-threatening complications. Herein, we present a novel case of hemorrhagic shock and hemoperitoneum after temporary epicardial pacing wire removal.
October 12, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28990962/two-stage-technique-used-to-manage-severe-upper-airway-obstruction-and-avoid-surgical-tracheostomy-a-case-report
#8
Desire N Onwochei, Kariem El-Boghdadly, Imran Ahmad
Severe upper airway obstruction is commonly managed with surgical tracheostomy under local anesthesia. We present a 49-year-old woman with postradiotherapy laryngeal fixation and transglottic stenosis for dilation of a pharyngeal stricture who refused elective tracheostomy. A 2-stage technique was used, which involved an awake fiberoptic intubation, followed by the transtracheal insertion of a Cricath needle and ventilation using an ejector-based Ventrain device. We discuss management aspects of this clinical scenario and the principles by which the Ventrain works...
October 5, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28990961/six-month-follow-up-of-a-patient-with-a-retained-fascia-iliaca-catheter-a-case-report
#9
Lindsay K Borg, Gunjan Kumar, Natasha Funck, Inge Tamm-Daniels, Nicholas J Giori, Edward R Mariano
Retained catheters are a rare but known complication of continuous peripheral nerve block. To date there have been several case reports of retained catheters but none that include longer-term follow-up of the patient experience and outcomes. Here, we present the case of a retained fascia iliaca catheter used for analgesia after total hip arthroplasty that fractured during removal and was ultimately never retrieved. The patient initially experienced paresthesias emanating from the site of continuous peripheral nerve block catheter placement, but these issues resolved completely over several weeks...
October 5, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28990960/anesthesia-simulator-based-functional-capacity-evaluation-of-an-anesthesiologist-after-radial-fracture-a-case-report
#10
Ceferina Suarez, Jesús Maxide, Demian Szyld, Jose M Maestre
We used simulation as a job-specific functional capacity evaluation method after a distal radius fracture in an anesthesiologist. Treatment included open reduction followed by an internal fixation with an arthrodesis plate. The patient performed simulated anesthesia inductions to assess her response to endotracheal intubation, bag-mask ventilation, and the manual opening of the airway. Data collected helped to guide the rehabilitation protocol, and to assess pain and the time to safely return to work. The patient began her clinical duties after 7 weeks of therapy and was able to fully perform her daily tasks with confidence, and full functional capacity...
October 5, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28968259/intraoperative-venovenous-extracorporeal-membrane-oxygenation-during-thoracic-surgery-that-requires-1-lung-ventilation-a-case-report
#11
Yuri Miyamoto, Yusuke Nagamine, Takahisa Goto, Kiyoyasu Kurahashi
We report 3 cases of thoracic surgery that required 1-lung ventilation where venovenous extracorporeal membrane oxygenation was prophylactically used because severe hypoxemia and ventilatory failure were anticipated intraoperatively. The surgery was successfully completed in all 3 cases. However, we had to withdraw the extracorporeal membrane oxygenation support in 1 case because of uncontrollable hemorrhage. Venovenous extracorporeal membrane oxygenation is a feasible option when severe hypoxemia and/or ventilatory failure is anticipated during 1-lung ventilation...
September 29, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28968258/anesthetic-considerations-for-a-child-with-rare-b3galt6-mutations-a-case-report
#12
Megan Brockel, Kathryn Chatfield, David Mirsky, Christopher D Baker, Norah Janosy
A rare autosomal recessive disorder caused by mutations in the B3GALT6 gene on chromosome 1p36 results in deficiency of β-1,3-galactosyltransferase 6, an enzyme critical for glycosaminoglycan biosynthesis. Defects in this gene result in a phenotype that has features of both skeletal dysplasia and a connective tissue disorder. The anesthetic considerations for children with this disorder have not previously been described. We report a collaborative, multidisciplinary approach to the perioperative care of a child with B3GALT6 mutations with severe phenotypic expression...
September 29, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28953490/anterior-laryngeal-web-leading-to-unanticipated-difficult-tracheal-intubation-in-a-neonate-diagnosed-and-managed-successfully-with-cmac-video-laryngoscope-a-case-report
#13
Anju Gupta, Nishkarsh Gupta
Anterior laryngeal web is a rare anomaly which is usually asymptomatic in infancy. This translates into a high incidence of unanticipated difficult intubation in these patients with consequent airway morbidity in the form of tracheostomy. We are reporting a case of unsuspected difficult intubation in a neonate due to the presence of a congenital anterior laryngeal web. After multiple failed intubation attempts with direct laryngoscopy, use of CMAC video laryngoscope improved the glottic view, enabled us to diagnose the presence of a thick anterior laryngeal web and intubate the child...
September 26, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28953489/effects-of-ketamine-on-pupillary-reflex-dilation-a-case-report
#14
Sérgio Vide, Catarina M Costa, Pedro L Gambus, Pedro P Amorim
Ketamine is an important component of multimodal treatment and a commonly used anesthetic drug. However, its analgesic effects have not been fully assessed intraoperatively because of difficulties in measuring this effect. In this case report, a woman underwent general anesthesia with ketamine and its pupillary reflexes were measured to detect autonomic changes in response to pain. With increasing doses of ketamine, the pupillary light reflex and the pupillary dilation response decreased. This could be caused by N-methyl-D-aspartate receptor antagonism in the pupillary reflexes pathway or by the analgesic effects of ketamine...
September 26, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28953488/iatrogenic-transection-of-an-arterial-cannula-and-the-successful-use-of-ultrasound-to-locate-the-retained-intraarterial-fragment-a-case-report
#15
Andrew C Leatherbarrow, Alina Bucata
We report a rare case of iatrogenic arterial cannula transection during a dressing change and migration of the distal fragment within the radial artery. The retained intraarterial fragment was successfully located using ultrasound, enabling swift surgical removal. We discuss the risk factors associated with arterial cannula transection and the efficacy of imaging modalities in locating the intraarterial fragment.
September 26, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28953487/spontaneous-respiration-using-intravenous-anesthesia-and-high-flow-nasal-oxygen-strive-hi-management-of-acute-adult-epiglottitis-a-case-report
#16
Phillip Kwan-Giet Lee, Anton Willis Gerard Booth, Kim Vidhani
High-flow nasal oxygen (HFNO) is a potentially life-saving adjunct in the emergency management of the obstructed airway. HFNO has multiple beneficial applications in critical care and respiratory support, but its use in emergency-obstructed airway management has not been defined. This case report describes spontaneous respiration using intravenous anesthesia and high-flow nasal oxygen to successfully manage acute adult epiglottitis with rapidly progressing airway obstruction. Oxygenation, carbon dioxide levels, and airway patency were maintained, which facilitated endotracheal intubation while the patient was spontaneously breathing during general anesthesia...
September 26, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28937424/a-case-report-of-incidental-hepatic-cysts-found-on-ultrasound-imaging-implications-for-the-anesthesiologist
#17
Aysha Hasan, Walid Alrayashi, David Waisel, Karen Boretsky
Point-of-care ultrasound imaging is increasingly used by anesthesiologists to facilitate rapid clinical diagnosis and treatment in the perioperative period. With its growing popularity, inevitably, unfamiliar structures will be observed. We present a case of cystic liver lesions in a healthy model during a point-of-care workshop. We address the clinical, ethical, and legal implications of incidental findings in anesthesiology. We offer recommendations and an algorithmic approach to these occurrences.
September 20, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28937423/deep-serratus-plane-catheter-for-management-of-acute-postthoracotomy-pain-after-descending-aortic-aneurysm-repair-in-a-morbidly-obese-patient-a-case-report
#18
Renuka M George, Maria Yared, Sylvia H Wilson
Regional procedures for postthoracotomy pain control have classically focused on paravertebral blocks and thoracic epidurals; however, these techniques may be challenging in an increasingly obese population and contraindicated with numerous anticoagulant and antiplatelet agents. While less studied, truncal blocks allow analgesic intervention for this growing patient cohort. This case report describes placement of a deep serratus anterior plane catheter in an intubated, morbidly obese patient with a lumbar drain who failed extubation secondary to acute postthoracotomy pain...
September 20, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28937422/placement-of-stimulating-epidural-catheter-for-a-patient-with-large-scapular-sarcoma-a-case-report
#19
James D Turner, Sean W Dobson, Robert S Weller, Christopher M Lack, Daryl S Henshaw
We report the use of continuous electrical stimulation to assist with the preoperative placement of a thoracic epidural which was used to provide postoperative analgesia in a patient undergoing excision of a large scapular sarcoma. The size of the sarcoma and the surrounding area required to maintain a sterile surgical field necessitated that the epidural catheter be inserted several vertebral interspaces caudal to the level of desired catheter tip termination. The use of electrical stimulation allowed for sequential intercostal muscle stimulation during threading, which enabled the placement of the catheter tip at the appropriate spinal level to optimize analgesia...
September 20, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28937421/methylene-blue-to-treat-refractory-latex-induced-anaphylactic-shock-a-case-report
#20
Paulo Sergio Da Silva, Paula Furtado
Anaphylaxis occurs in 1/5000-1/20,000 of anesthesia cases and may evolve with shock and cardiovascular collapse in up to 54% of cases. Mortality varies from 3% to 10%. Latex is the second leading cause of anaphylaxis during the perioperative period. We report a case of latex-induced anaphylactic shock refractory to the usual catecholamine treatment that was reversed with the aid of methylene blue. Exaggerated activation of the nitric oxide-cyclic guanosine monophosphate pathway is observed in refractory shock...
September 20, 2017: A & A Case Reports
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