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A & A Case Reports

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https://www.readbyqxmd.com/read/28306584/serratus-anterior-plane-block-to-address-post-thoracotomy-and-chest-tube-related-pain-a-report-on-3-cases
#1
George M Chu, G Craig Jarvis
In this case report, the serratus anterior plane block was used in conjunction with multilevel continuous thoracic paravertebral blocks (TPVB) and general anesthesia in 3 thoracotomy cases. All blocks were accompanied by use of catheters that allowed continuous local anesthetic infusions and intermittent local anesthetic bolus injections to address postoperative pain. In all 3 patients, the serratus anterior plane block provided analgesia for chest tube-related pain that was not provided by the TPVB alone.
March 16, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28306583/successful-resuscitation-following-massive-obstetric-hemorrhage-in-a-patient-of-the-jehovah-s-witness-faith-a-case-report
#2
Richard M Hubbard, Jonathan H Waters, Mark H Yazer
Hemorrhage is a leading cause of maternal morbidity and mortality worldwide. It is especially difficult to treat in patients of the Jehovah's Witness faith because they refuse certain blood products. This case report describes the resuscitation of a parturient Jehovah's Witness whose postcesarean delivery course was complicated by massive hemorrhage from unrecognized arterial bleeding in the intensive care unit with significant hemodynamic instability that necessitated an emergency bedside laparotomy. Her hemoglobin nadir was 1...
March 16, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28306582/in-response
#3
Joss Thomas, Franklin Dexter, Michael M Todd
No abstract text is available yet for this article.
March 16, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28306581/spinal-cord-stimulation-treatment-for-persistent-pain-after-a-burn-injury-a-case-report
#4
Takeshi Kubota, Yuuhei Ishikawa, Rie Ishikawa
Spinal cord stimulation (SCS) is used to treat neuropathic pain, but there are no published studies on its use to treat burn pain. We used SCS to treat a 67-year-old man suffering from burn pain that could not be managed with high-dose opioids or adjuvant neuropathic analgesics. A trial of SCS markedly reduced the visual analog scale score for pain in the left lateral abdominal and gluteal regions. He underwent permanent implantation of a SCS and achieved an opioid-free state. This case suggests that SCS treatment is a therapeutic option for burn pain refractory to conventional therapy...
March 16, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28306580/comment-on-growth-in-an-anesthesiologist-and-nurse-anesthetist-supervised-sedation-nurse-program-using-propofol-and-dexmedetomidine
#5
Joseph P Cravero, Randall P Flick, Shobha V Malviya
No abstract text is available yet for this article.
March 16, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28306579/continuous-epidural-analgesia-using-an-ester-linked-local-anesthetic-agent-2-chloroprocaine-during-labor-a-case-report
#6
Simon C Lee, Vanessa Moll
We report the use of the ester-linked local anesthetic, 2-chloroprocaine, for continuous epidural analgesia in a patient in labor with a history of allergic reaction to amide local anesthetics. The patient gave a reliable history of pruritus, hives, erythema, and swelling on her lower extremity after having received a preservative-free amide local anesthetic. This allergy had been confirmed by a dermatologist by her reports. The patient requested an epidural for labor analgesia that was placed successfully...
March 16, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28306578/selective-low-volume-nerve-block-for-the-open-surgical-fixation-of-a-midshaft-clavicle-fracture-in-a-conscious-high-risk-patient-a-case-report
#7
Carlos I Salvadores de Arzuaga, José M Naya Sieiro, Oscar Salmeron Zafra, Miguel A González Posada, Esther Marquez Martínez
We report a case of successful intraoperative management using only low-volume regional anesthesia for the open surgical fixation of a traumatic clavicle fracture in a conscious 69-year-old man with severe chronic obstructive pulmonary disease. To avoid general anesthesia, we provided low-volume C5 and C6 nerve root blocks along with a superficial cervical plexus block using only 9 mL of anesthetic solution to avoid the often encountered complications of higher volume injections. Throughout the procedure, the patient remained comfortable and cooperative with stable hemodynamics and respiration...
March 16, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28306577/peer-assisted-analysis-of-resident-feedback-improves-clinical-teaching-a-case-report
#8
Christine L Mai, Keith Baker
Anesthesiologists play an important role in educating future clinicians. Yet few residency programs incorporate teaching skills into faculty development. Consequently, many anesthesiologists have limited training to supervise and educate residents. In turn, these attendings may receive negative feedback and poor evaluations from residents without a means to effectively improve. Peer-assisted teaching between faculty members may serve as a strategy to improve teaching skills. We report a case of peer-assisted analysis of resident feedback to identify specific areas of concern that were targeted for improvement...
March 16, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28252543/anesthetic-management-of-a-patient-with-multiple-previous-episodes-of-postanesthesia-care-unit-delirium-a-case-report
#9
Matthias Kreuzer, Matthew K Whalin, September D W Hesse, Margaret A Riso, Paul S García
We report the case of a 37-year-old female patient who required 22 surgeries following a pedestrian versus car accident. She was enrolled in a clinical study investigating emergence from anesthesia. In 10 of her 22 surgeries, we assessed her cognitive status in the postanesthesia care unit (PACU) using the Confusion Assessment Method. We observed PACU delirium in all 4 cases in which the patient received sevoflurane, but only in 1 of 6 cases in which she received propofol. The patient showed EEG α-band activity similar to that of an elderly patient who may reflect a greater risk of PACU delirium...
March 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28252542/regional-anesthesia-with-noninvasive-ventilation-for-shoulder-surgery-in-a-patient-with-severe-chronic-obstructive-pulmonary-disease-a-case-report
#10
Fabrice Ferré, Nina Cugnin, Charlotte Martin, Philippe Marty, Nicolas Bonnevialle, Matt Kurrek, Vincent Minville
Interscalene block (ISB) impairs ipsilateral lung function and generally is not used for patients with respiratory insufficiency. We present a 49-year-old man with chronic obstructive pulmonary disease scheduled for shoulder surgery. He was given a regional technique with an ISB (short-acting local anesthetic to minimize duration of diaphragmatic dysfunction) and suprascapular and axillary nerves blocks (long-acting local anesthetic). He was supported with noninvasive ventilation during the time of hemidiaphragmatic paralysis as documented by serial ultrasound examination...
March 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28252541/hematoma-after-transversus-abdominis-plane-block-in-a-patient-with-hellp-syndrome-a-case-report
#11
Kazuhiro Shirozu, Sumiko Kuramoto, Saki Kido, Kengo Hayamizu, Yuji Karashima, Sumio Hoka
We herein present a case of intramuscular hematoma that developed after transversus abdominis plane block in a patient undergoing cesarean delivery. The patient had HELLP syndrome (hemolysis, elevated liver enzymes, and low platelet count) preoperatively. Ultrasonography-guided transversus abdominis plane block was performed at the end of surgery. Postoperatively, the platelet count and antithrombin III level decreased, and computed tomography revealed intramuscular hematomas that possibly were related to vascular injury and potential disseminated intravascular coagulation...
March 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28252540/retrograde-extrusion-of-coronary-thrombus-during-urgent-aortocoronary-bypass-surgery-a-case-report
#12
Glenio B Mizubuti, Yuri Koumpan, G Andrew Hamilton, Rachel Phelan, Anthony M H Ho, Robert C Tanzola, Louie T S Wang
A 73-year-old man underwent urgent coronary artery bypass grafting after an acute myocardial infarction. An angiogram had revealed multivessel disease with a circumflex artery lesion suspected as the primary culprit. On separation from cardiopulmonary bypass, transesophageal echocardiography revealed a new mobile mass in the aortic root. Cardiopulmonary bypass was reinstituted and a large thrombus emanating from the left coronary ostium was surgically removed. We hypothesize that the thrombus had originated from coronary retrograde extrusion during venous grafting...
March 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28252539/continuous-erector-spinae-plane-block-for-rescue-analgesia-in-thoracotomy-after-epidural-failure-a-case-report
#13
Mauricio Forero, Manikandan Rajarathinam, Sanjib Adhikary, Ki Jinn Chin
The ultrasound-guided erector spinae plane (ESP) block is a newly described technique for providing thoracic analgesia. It is simple to perform and relatively noninvasive compared with thoracic epidural analgesia. In addition, the anatomy lends itself well to catheter insertion for continuous blockade. In this report, we describe the use of the ESP block as a rescue analgesic technique for postthoracotomy analgesia in a patient with failed thoracic epidural analgesia.
March 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28181949/lumbar-epidural-blood-patch-via-a-caudal-catheter-after-surgical-dural-tear-and-failed-repair-a-case-report
#14
Michael Dorbad, John Han, Shaik Ahmed, Brian Monroe, Michael Entrup
We report a patient who developed a positional headache and pseudomeningocele after multiple lumbar surgeries for low back and radicular pain. An epidural blood patch via a lumbar approach was not feasible as a result of distorted lumbar anatomy after multiple back surgeries. An epidural blood patch was performed via catheter-threaded cephalad from a caudal approach. The patient had immediate relief after the procedure and at 1 year was still symptom-free. This combination technique may be considered as an alternative approach when a percutaneous lumbar epidural blood patch is disadvantageous...
February 8, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28181948/kounis-syndrome-during-anesthesia-presentation-of-indolent-systemic-mastocytosis-a-case-report
#15
Elena de la Fuente Tornero, Arantza Vega Castro, Pedro Álvarez de Sierra Hernández, Javier Balaguer Recena, Sofía Carmen Zaragoza Casares, Francisco Miguel Serrano Baylin, Paloma Gallardo Culebradas, Beatriz Amorós Alfonso, Jose Ramón Rodríguez Fraile
Mastocytosis comprises a heterogeneous group of disorders characterized by mast cell accumulation and proliferation in distinct organs. Kounis syndrome is defined as the concurrence of acute coronary syndromes with mast cell activation in a setting of allergic or hypersensitivity reactions. This is the first reported case of an intraoperative Kounis syndrome as the onset of an indolent systemic mastocytosis probably triggered by succinylated gelatin infusion during general anesthesia. The presentation of this case is intended to contribute to the knowledge of mastocytosis and Kounis syndrome at the time of diagnostic workup during intraoperative anaphylaxis or myocardial ischemia...
February 8, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28181946/case-report-of-midazolam-withdrawal-induced-catatonia-in-a-9-year-old-patient
#16
Cassandra R Duncan-Azadi, Peter N Johnson, Andrew Gormley
Benzodiazepine withdrawal-induced catatonia is a rare phenomenon in the adult population and has never been reported in a pediatric patient. We present a 9-year-old boy who exhibited catatonia symptoms following discontinuation of a midazolam infusion in the pediatric intensive care unit. The pediatric anesthesia acute pain team was consulted. When the patient's altered mental status could not otherwise be explained, benzodiazepine withdrawal-induced catatonia was considered. A dose of 2 mg intravenous lorazepam was given and the patient's symptoms dramatically improved within 5 minutes of administration...
February 8, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28181945/operating-room-management-and-the-business-of-anesthesia-innovative-solutions-to-bridge-the-educational-gap-in-residency-training-programs
#17
Scott M Wasilko, Chris Giordano
No abstract text is available yet for this article.
February 8, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28181944/management-of-a-patient-requiring-intrathecal-drain-insertion-and-removal-in-the-setting-of-concomitant-dual-antiplatelet-therapy-with-clopidogrel-and-aspirin-a-case-report
#18
Christopher W Connors, Janie D Nguyen
We report a case of deliberate intrathecal catheter insertion and removal in the setting of continuous dual-antiplatelet therapy with clopidogrel and aspirin. A patient with recently sited bare metal intracerebral stents developed severe symptomatic hydrocephalus and required temporary cerebrospinal fluid diversion. The risks of intracerebral in-stent thrombosis or delayed intervention precluded following guidelines for the management of clopidogrel in neuraxial procedures. Options to mitigate the risk of and facilitate the early detection of epidural hematoma are discussed when neuraxial instrumentation is indicated in the setting of clopidogrel and aspirin therapy...
February 8, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28181943/complete-antethoracic-block-for-analgesia-after-modified-radical-mastectomy-a-case-report
#19
Hidemasa Takahashi, Takeo Suzuki
Complete antethoracic block for modified radical mastectomy is a composite block comprising the antethoracic medial, antethoracic inferior, and antethoracic lateral blocks. The puncture targets of all components are easy to identify, and the risk of complications such as pneumothorax is low. Our patient was a 72-year-old woman undergoing modified radical mastectomy for breast cancer. After induction of general anesthesia, but before surgical incision, she received a complete antethoracic block for anesthesia, which also provided good analgesia postoperatively...
February 8, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28181942/successful-management-of-a-patient-with-possible-mast-cell-activation-syndrome-undergoing-pulmonary-embolectomy-a-case-report
#20
Ellen W Richter, Kai-Ling Hsu, Vanessa Moll
We report the successful perioperative management of a patient with presumed mastocytosis undergoing pulmonary embolectomy. Postoperatively the patient went into vasodilatory shock, which was partly attributed to mast cell mediator release. H1- and H2-antagonists, steroids, and a single dose of methylene blue were given with improvement of hemodynamics. The patient was weaned off vasoactive substances and extubated by postoperative day 2. We discuss the perioperative management of patients with mastocytosis, briefly review the literature concerning anesthetic management for cardiac surgery in patients with this disorder, and discuss our patient's alternative but related diagnosis of idiopathic mast cell activation syndrome...
February 8, 2017: A & A Case Reports
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