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A & A Case Reports

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https://www.readbyqxmd.com/read/28816708/single-incision-approach-to-implantation-of-the-pulse-generator-and-leads-for-dorsal-root-ganglion-stimulation-a-case-report
#1
Valery van Velsen, Noud van Helmond, Mitchell E Levine, Kenneth B Chapman
Dorsal root ganglion (DRG) stimulation has recently emerged as a treatment for persistent neuropathic pain, but the permanent implantation of stimulator leads and the pulse generator can be difficult and is sometimes associated with complications. We used a single-incision approach to tunnel and implant the leads and pulse generator for DRG stimulation treatment in a patient suffering from intractable foot pain. At long-term follow-up, the patient experienced a decrease in pain intensity and improvement in function, without any complications...
August 14, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28806177/laryngeal-mask-airway-embedded-with-pharyngeal-suction-catheters-for-rhinoplasty-a-case-report
#2
Gary X Zhou
A flexible laryngeal mask airway device (LMAD) embedded with 2 pharyngeal suction catheters was used for a young female patient who underwent a revision rhinoplasty, septoplasty, and chin implant. The modified LMAD was constructed by attaching 2 suction catheters onto the back of the mask; it functioned well without signs of malfunction or complications, with a total of 71 mL of blood evacuated from the pharyngeal area during the five and a half hour surgery. The patient emerged from anesthesia without coughing or straining, and reported no sore throat or nausea/vomiting in the recovery room...
August 10, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28806176/evaluating-the-use-of-ketamine-for-pain-control-with-sickle-cell-crisis-in-pregnancy-a-report-of-2-cases
#3
Alexis C Gimovsky, Kate Fritton, Eugene Viscusi, Amanda Roman
Sickle cell crises occur frequently during pregnancy and are difficult to treat, even with high-dose opioids. Analgesia with ketamine has been suggested as an alternative, but its use during pregnancy is underreported. Two pregnant patients with uncontrolled sickle cell pain were treated with ketamine. Patient A reported no decrease in her pain, but her opioid requirements decreased. Patient B's pain resolved during ketamine administration. No serious maternal or neonatal adverse effects occurred. Ketamine may be considered as an adjunct analgesic in pregnant patients with sickle cell pain, although prospective clinical data are needed to fully assess its efficacy...
August 10, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28806175/point-of-care-ultrasound-facilitated-detection-of-femoral-occlusive-septic-emboli-during-mitral-valve-surgery-a-case-report
#4
Melissa L Bellomy, Susan Eagle, Mias Pretorius, Ben R Barton, Yafen Liang
Acute lower extremity ischemia from septic emboli is a surgical emergency. Timely diagnosis and management are critical to improve patient outcome. However, traditional diagnostic modalities such as intraoperative angiogram are time-consuming, require special equipment and personnel, and introduce contrast exposure for critically ill patients. There are limited reports of utilization of point-of-care ultrasound to detect peripheral septic emboli. We present a case where femoral occlusive septic emboli were identified by point-of-care ultrasound after mitral valve replacement...
August 10, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28806174/left-ventricular-apex-venting-in-high-risk-redo-sternotomy-with-severe-aortic-insufficiency-a-case-report
#5
Brett J Wakefield, Alexander J Leone, Shiva Sale
Redo cardiac surgery in patients with severe aortic insufficiency can present unique challenges to the anesthesiologist. We report a case highlighting the challenge and importance of interdisciplinary planning between cardiothoracic surgeons and anesthesiologists prior to high-risk surgery. Failure to place an endoaortic balloon and percutaneous coronary sinus catheter due to anatomical abnormalities prompted the adoption of an alternate technique involving apical ventricular venting to assist sternal reentry...
August 10, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28795988/eltrombopag-to-treat-thrombocytopenia-during-last-month-of-pregnancy-in-a-woman-with-myh9-related-disease-a-case-report
#6
Remi Favier, Celine De Carne, Elisabeth Elefant, Ruxanda Lapusneanu, Vasiliki Gkalea, Agnès Rigouzzo
MYH9-related disease (MYH9-RD) is an inherited rare autosomal dominant macrothrombocytopenia. Patients with MYH9-RD have giant platelets and leukocyte inclusion bodies caused by mutations in the MYH9 gene encoding the non-muscle myosin heavy chain II-A. Before identification of the causative gene, patients were diagnosed as Epstein or Fechtner or Sebastian syndromes or May-Hegglin anomaly. As with other inherited thrombocytopenias, the risk of increased bleeding during perioperative period or delivery is a major concern...
August 8, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28795987/pre-eclampsia-in-a-pregnant-melas-female
#7
Josef Finsterer, Sinda Zarrouk-Mahjoub
No abstract text is available yet for this article.
August 8, 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
#8
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...
August 3, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28786850/intraoperative-and-postoperative-management-of-a-case-of-an-airway-fire
#9
Osman Nawazish Salaria, Rekha Suthar, Sarah Abdelfattah, Jason Hoyos
Accidental fire can occur with upper airway injury and can be fatal if inappropriately managed. Effective communication between the anesthetic and the surgical teams can reduce the risk of such an adverse event. Understanding the interaction between fuel, oxidizer, and ignition source in an airway fire may also reduce the incidence. The literature on upper airway thermal injury has focused on prevention and intraoperative management, but few studies have described postburn management. In this report, we describe the intraoperative occurrence of an airway fire during a surgical tracheostomy and subsequent patient management...
August 3, 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
#10
Monica S Shah, Susan T Verghese
No abstract text is available yet for this article.
August 1, 2017: A & A Case Reports
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
#11
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...
August 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...
August 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28767478/a-case-report-on-ultrasound-guided-serratus-plane-block-and-fast-track-tracheal-extubation-in-the-operating-room-for-thoracic-trauma-patients-is-it-possible
#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...
August 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28767477/a-simple-and-effective-way-to-secure-a-laryngeal-mask-airway-mask-in-place
#14
Shahram Shokohi, Mir Mousa Aghdashi
No abstract text is available yet for this article.
August 1, 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
#15
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...
August 1, 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
#16
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...
August 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28767474/intraoperative-pulmonary-embolism-a-case-report-emphasizing-the-utility-of-electrocardiogram
#17
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...
August 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28767473/acquired-hemophilia-a-after-hepatic-yttrium-90-radioembolization-a-case-report
#18
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...
August 1, 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
#19
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...
August 1, 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
#20
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...
August 1, 2017: A & A Case Reports
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