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A & A Case Reports

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https://www.readbyqxmd.com/read/27898550/severe-intraoperative-shock-related-to-mesenteric-traction-syndrome
#1
Alfredo Haack Couto, Hugo Siqueira, Pablo Pulcheira Brasileiro, Ismar Lima Cavalcanti, Rogério Luiz da Rocha Videira
Mesenteric traction syndrome is defined as arterial hypotension, facial flushing, and tachycardia related to mesenteric traction. We describe a case of mesenteric traction syndrome refractory to catecholamine and vasopressin infusions. The patient, who had Crohn disease, developed severe distributive shock after mesenteric traction while undergoing resection of an intestinal inflammatory mass, accompanied by facial flushing and unaltered readings for pulse oximetry, capnography, and bispectral index monitoring...
November 28, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27898549/hypertensive-crisis-during-norepinephrine-syringe-exchange
#2
Roland A Snijder, Johannes T A Knape, Toine C G Egberts, Annemoon M D E Timmerman
A 67-year critically ill patient suffered from a hypertensive crisis (200 mm Hg) because of a norepinephrine overdose. The overdose occurred when the clinician exchanged an almost-empty syringe and the syringe pump repeatedly reported an error. We hypothesized that an object between the plunger and the syringe driver may have caused the exertion of too much force on the syringe. Testing this hypothesis in vitro showed significant peak dosing errors (up to +572%) but moderate overdose (0.07 mL, +225%) if a clamp was used on the intravenous infusion line and a large overdose (0...
November 28, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27898548/two-cardiac-arrests-because-of-venous-air-embolism-during-endoscopic-retrograde-cholangiopancreatography
#3
Joseph M Sisk, Monica D Choi, Andrew B Casabianca, Ali M Hassan
Venous air embolism is a rare but potentially catastrophic complication of endoscopic retrograde cholangiopancreatography. We report 2 cases of venous air embolism and subsequent cardiac arrests. During resuscitation efforts, a transesophageal echocardiogram was placed, which demonstrated significant air in the right heart. Although gastroenterologists seem to be more aware of this complication, it is underreported in the anesthesiology literature. As anesthesiologists continue to expand coverage to endoscopy suites, anesthesia providers must be aware of predisposing factors and maintain a high index of suspicion to recognize and treat in a timely manner to prevent serious adverse outcomes...
November 28, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27898547/bilateral-congenital-iris-sphincter-agenesis-diagnosed-after-massive-bleeding-episode-during-repair-of-aneurysmal-dilation-of-patent-ductus-arteriosus
#4
Tomohiro Yamamoto, Martin Schmidt-Niemann, Ehrenfried Schindler
We report a rare case of an infant with both an aneurysmal dilation of the patent ductus arteriosus (PDA) and bilateral congenital iris sphincter agenesis. Her mydriasis without pupillary light reflex was first noted after a massive intraoperative bleeding episode during the PDA ligation. The assumption that the mydriasis was a sign of cerebral ischemia led to additional examinations and intensive medical therapies that in retrospect were unnecessary. This is the first reported case of combined aneurysmal dilation of a PDA and congenital iris sphincter agenesis in the anesthesia literature...
November 28, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27898546/lateral-position-for-cesarean-delivery-because-of-severe-aortocaval-compression-in-a-patient-with-marfan-syndrome-a-case-report
#5
John C Coffman, Russell L Legg, Catherine F Coffman, Kenneth R Moran
Prompt recognition and management of hypotension resulting from aortocaval compression syndrome are essential to optimize the maternal and fetal outcomes. Management involves increasing leftward uterine displacement and sometimes full lateral positioning, although lateral position during cesarean delivery is typically considered to be impractical. We report an obstetric patient case of severe aortocaval compression syndrome resulting in hypotension and loss of consciousness that ultimately underwent cesarean delivery under general anesthesia in the lateral position...
November 28, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27861178/use-of-prothrombin-complex-concentrate-for-warfarin-reversal-before-the-performance-of-an-epidural-blood-patch-in-a-patient-with-cortical-vein-thrombosis-and-subdural-hematoma
#6
Kallol Chaudhuri, Cooper W Phillips, Swapna Chaudhuri, John Wasnick
Compared to conventional therapy, several studies with prothrombin complex concentrate (PCC) have recently demonstrated its superior efficacy in rapidly replacing vitamin K-dependent factors for patients with life-threatening hemorrhage. We present a novel use of PCC in a patient with intracranial hypotension, who had received warfarin for treatment of cortical vein thrombosis. However, after anticoagulation, she proceeded to develop bilateral subdural hematomas with descent of cerebellar tonsils. Given the possibility of an occult dural puncture during labor analgesia, an epidural blood patch was performed after administration of PCC and normalization of coagulation parameters, with prompt improvement of the patient's headache...
November 17, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27861177/iatrogenic-right-coronary-artery-occlusion-following-tricuspid-valve-repair-case-report-of-a-rare-but-recognized-complication
#7
Bradford B Smith, Mark M Smith, Kent H Rehfeldt
Iatrogenic occlusion of the right coronary artery (RCA) is a rare complication after tricuspid valve surgery. We review the case of a 74-year-old female who presented for mitral and tricuspid valve annuloplasty. Unanticipated postcardiopulmonary bypass biventricular hypokinesis was encountered, necessitating extracorporeal support. Emergent coronary angiography demonstrated near-complete RCA occlusion from a taut periarterial suture near the RCA. Deployment of a drug-eluting stent restored normal flow, and the patient made a full recovery...
November 17, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27861176/low-cardiac-output-after-orthotopic-heart-transplant-secondary-to-large-inferior-vena-cava-thrombus-after-prothrombin-complex
#8
Kimberly Ann Pollock, Zeb McMillan, Gert Diederick Pretorius, Brett Cronin
Low cardiac output after orthotopic heart transplant (OHT) may be attributed to inadequate preload, vasodilation, and/or reduced inotropy. Inadequate preload because of an inferior vena cava (IVC) thrombus is a rare cause of low cardiac output and not frequently described in the literature. Although the use of prothrombin complex (PCC) has been associated with thrombus formation, its contribution to life-threatening IVC thrombosis has yet to be described. This case report describes the use of perioperative ultrasound in the diagnosis and management of a low cardiac output state induced by an IVC thrombus in an OHT recipient who received PCC...
November 17, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27828784/peripheral-neuromodulation-for-the-treatment-of-postamputation-neuroma-pain
#9
Kaare Meier, Thomas F Bendtsen, Jens Christian Sørensen, Lone Nikolajsen
Neuroma pain can be severe, persistent, and treatment resistant. We present a case of a 37-year-old female amputee who suffered from severe neuroma pain, which had proved resistant to pharmacologic treatment, glycerol injections, spinal cord stimulation, radiofrequency thermocoagulation, and repeated surgical removals. After treatment with peripheral nerve stimulation, using a St. Jude Medical Octrode lead implanted percutaneously under ultrasound guidance close to her painful neuroma, her ongoing pain dramatically decreased from 8 to 3 on a numeric rating scale (0-10)...
November 8, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27828783/transversus-abdominis-plane-block-for-inguinal-hernia-repair-in-a-premature-infant-a-low-risk-high-benefit-technique
#10
Rashmi Ramachandran, Sumit Bansal, Preeti Yadav, Vimi Rewari
In this report, we describe the case of a premature infant (36 weeks' postgestational age) who underwent left inguinal hernia repair under general anesthesia without the use of any airway device. Anesthesia was induced and maintained with sevoflurane in oxygen and nitrous oxide. An ultrasound-guided transversus abdominis plane block was performed that provided effective analgesia, obviating the need for opioids in the intraoperative period. The infant's hemodynamics remained stable throughout the surgery. This report also briefly explains the advantages of using a transversus abdominis plane block, compared with neuraxial blockade, for hernia repair surgery...
November 8, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27828782/pheochromocytoma-multisystem-crisis-triggered-by-glucocorticoid-administration-and-aggravated-by-citrate-dialysis
#11
Chuen Jye Yeoh, Shin Yi Ng, Brian K P Goh
Pheochromocytoma multisystem crisis is the most severe presentation of pheochromocytoma. We report on a 68-year-old survivor of pheochromocytoma multisystem crisis, whose clinical course was triggered inadvertently by a short innocuous course of oral dexamethasone to suppress inflammation and swelling after a left orbital floor fracture repair. He presented first with severe epigastric pain and headache, and subsequently experienced insults to neurological, cardiac, respiratory, hepatobiliary, renal, and immune system in his prolonged intensive care unit stay...
November 8, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27828781/tracheal-extubation-of-patients-with-cervical-spine-injury-a-case-report-and-review-of-literature
#12
Aleksandra Nowicka, Narcis Ungureanu, Shyam Balasubramanian, Cyprian Mendonca
In patients with cervical spine injuries, emergence from anesthesia and tracheal extubation can prove as challenging to the anesthesiologist as the tracheal intubation. We report a case of a patient with a potentially unstable cervical spine injury who presented for a nonspinal surgery and experienced agitation on emergence from anesthesia. The use of an intravenous sedative was necessary to ensure cervical spine immobilization but was complicated by severe respiratory depression and the need for reintubation and admission to intensive care...
November 8, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27811496/a-case-report-of-onyx-pulmonary-arterial-embolism-contributing-to-hypoxemia-during-awake-craniotomy-for-arteriovenous-malformation-resection
#13
Brian T Tolly, Jenna L Kosky, Antoun Koht, Laura B Hemmer
A healthy 26-year-old man with cerebral arteriovenous malformation underwent staged endovascular embolization with Onyx followed by awake craniotomy for resection. The perioperative course was complicated by tachycardia and severe intraoperative hypoxemia requiring significant oxygen supplementation. Postoperative chest computed tomography (CT) revealed hyperattenuating Onyx embolization material within the pulmonary vasculature, and an electrocardiogram indicated possible right heart strain, supporting clinically significant embolism...
November 2, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27811495/use-of-methohexital-and-dexmedetomidine-for-maintenance-of-anesthesia-in-a-patient-with-mitochondrial-myopathy
#14
Elliott L Woodward, Zhiling Xiong
Provision of anesthesia for patients with mitochondrial disorders is associated with a unique set of challenges. These disorders are rare, which complicates efforts to develop high quality, evidence-based guidelines to inform the perioperative management of those who suffer from them. Accordingly, case reports remain an important source of information regarding their care. Here we present the case of a 27-year-old female patient with mitochondrial myopathy and a history suggestive of malignant hyperthermia susceptibility who received general anesthesia for 2 consecutive surgeries...
November 2, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27811494/successful-treatment-of-persistent-pain-after-pectus-excavatum-repair-using-paravertebral-nerve-radiofrequency-thermoablation
#15
Hannah Noemi Ladenhauf, Ottokar Stundner, Rudolf Likar, Jörg Schnöll, Roman P Metzger
We present a case of a 25-year-old male patient suffering from severe prolonged pain after uneventful pectus excavatum repair that could be treated successfully by paravertebral nerve radiofrequency thermoablation. The patient was scheduled for a minimally invasive Nuss pectus excavatum repair. Surgical correction was performed under general anesthesia in combination with a thoracic peridural catheter. The immediate postoperative course was uneventful; however, the patient developed severe prolonged bilateral chest wall pain across segments T8 and T9...
November 2, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27811493/failed-vocalis-muscle-monitoring-during-thyroid-surgery-resulting-from-residual-muscle-relaxation
#16
Marie-Luise Ruebsam, Christian Hoenemann
Postoperative paralysis of the vocal cords resulting from intraoperative surgical injury of the recurrent laryngeal nerve is one of the most serious complications of elective thyroid surgery. The chance of injury is reduced by using intraoperative neuromonitoring (IONM). This educational report describes a case of IONM failure resulting from residual muscle relaxation that was restored by administration of sugammadex. It discusses possible pharmacology explanations and provides recommendations for how to prevent this situation in daily practice...
November 2, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27811492/massive-subcutaneous-emphysema-and-bilateral-tension-pneumothoraces-after-supplemental-oxygen-delivery-via-an-airway-exchange-catheter
#17
Abraham H Hulst, Hans J Avis, Markus W Hollmann, Markus F Stevens
A patient suffered massive subcutaneous emphysema and bilateral tension pneumothoraces after receiving supplemental oxygen through an airway exchange catheter (AEC). Complications of AEC placement include misplacement, direct injury to the larynx, bronchi or lung, barotrauma related to oxygen supplementation, and a loss of airway. We review these complications and discuss the specific risks of supplementing oxygen using an AEC. We suggest measures to limit pressure from the oxygen source and warn against advancing an AEC too far into the tracheobronchial tree...
November 2, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27782908/optimization-of-mechanical-ventilation-in-a-31-year-old-morbidly-obese-man-with-refractory-hypoxemia
#18
Changsheng Zhang, Massimiliano Pirrone, David A E Imber, Jeanne B Ackman, Jacopo Fumagalli, Robert M Kacmarek, Lorenzo Berra
Morbidly obese, critically ill patients are prone to develop hypoxemic respiratory failure and ventilator dependency. The best method for recruiting the lungs of these patients and keeping alveoli open without causing injury remains unclear. We present the case of a 31-year-old patient with severe refractory hypoxemia reversed by lung recruitment maneuvers and subsequent application of positive end-expiratory pressure (PEEP) at a level determined by a decremental PEEP trial. The patient was extubated at a high PEEP level of 22 cm H2O followed by noninvasive ventilatory support after extubation...
October 24, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27782907/garlic-induced-surgical-bleeding-how-much-is-too-much
#19
Anna Woodbury, Roman Sniecinski
A patient underwent C2-T2 decompression and fusion with excessive intraoperative bleeding and no clear source. The patient denied the use of blood-thinning medications, but had consumed the equivalent of 12 g garlic daily in the days leading up to the surgery. He was treated with desmopressin acetate (DDAVP) and cryoprecipitate with adequate control of bleeding. Garlic is known to have an antiplatelet effect, although the dose range necessary to create a bleeding abnormality has not yet been well described nor has the effect of taking garlic with sertraline or other agents with an established or potential effect on coagulation...
October 24, 2016: A & A Case Reports
https://www.readbyqxmd.com/read/27749295/difficulty-inserting-cuffed-endotracheal-tubes-in-a-child
#20
Keiko Imai, Taku Doi, Kenji Kayashima
We experienced difficulty inserting cuffed inner diameter (ID) 4.5- and 5.0-mm endotracheal tubes (ETTs) in a 5-year-old boy. Postoperative ultrasound investigations showed that the internal transverse width of the cricoid cartilage was 8.0 mm. The maximum outer diameter (OD) of the deflated cuff portion of the cuffed ID 4.5- and 5.0-mm ETTs was 8.5 and 9.6 mm, respectively. The OD of an uncuffed ID 5.5-mm ETT was 7.6 mm; this tube passed the cricoid cartilage. Hence, the transverse width of the cricoid cartilage and ETT diameter including cuff folds should be considered when selecting cuffed ETTs...
October 5, 2016: A & A Case Reports
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