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A & A Case Reports

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https://www.readbyqxmd.com/read/28181949/lumbar-epidural-blood-patch-via-a-caudal-catheter-after-surgical-dural-tear-and-failed-repair-a-case-report
#1
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
#2
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/28181947/fiberoptic-guided-blue-rhino-dilator-assisted-dilation-of-postintubation-tracheal-stenosis-a-case-report-about-a-novel-technique
#3
Nishkarsh Gupta, Prasant Sahoo, Karan Madan, Sachidanand Jee Bharti
Posttracheostomy tracheal stenosis is a rare complication of prolonged tracheal intubation. Treatment modalities that may be used include surgical resection and anastomosis, endoscopic tracheal dilation, laser resection, and tracheal stenting. We describe a novel salvage modality for dilation of a symptomatic tracheal stenosis using a percutaneous tracheostomy dilator wherein rigid bronchoscopic dilation was not feasible and balloon tracheal dilation had failed.
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
#4
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
#5
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
#6
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
#7
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
#8
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
https://www.readbyqxmd.com/read/28166109/whether-to-proceed-with-deep-brain-stimulator-battery-change-in-a-patient-with-signs-of-potential-sepsis-and-parkinson-hyperpyrexia-syndrome-a-case-report
#9
Chyong-Jy Joyce Liu, Anica Crnkovic, John Dalfino, Leina Yoko Singh
Parkinsonism-hyperpyrexia syndrome (PHS) is a neurologic emergency associated with anti-Parkinson medication withdrawal; however, its clinical presentation mimics sepsis. We describe the case of a 69-year-old man with advanced Parkinson disease who presented for exchange of the depleted battery in his subthalamic deep brain stimulator. The patient's preoperative symptoms of fever, rigidity, altered consciousness, and autonomic instability presented a dilemma whether to proceed with battery exchange to treat PHS or postpone surgery due to potential sepsis...
February 3, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28166108/short-term-vision-loss-following-whipple-surgery-a-case-report
#10
Lakshman Gollapalli, Aashish J Kumar, Kunal Sood, Rudram Muppuri
Occipital seizures may result in visual deficits and may be an ictal or postictal phenomenon. A 71-year-old woman underwent pancreatoduodenectomy (Whipple procedure). During recovery in the postanesthesia care unit, the patient complained of blindness. Upon transfer to the intensive care unit, an electroencephalogram indicated bilateral occipital and hemispheric seizure activity. The patient was treated with antiseizure medication, and vision normalized within 3 days. Subtherapeutic concentration of free phenytoin was confirmed...
February 3, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28166107/challenges-in-the-anesthetic-management-for-a-robotic-thymectomy-in-a-patient-with-myasthenia-gravis-a-case-report
#11
Susan M Martinelli, Bilal D Lateef, Jason M Long, David Y Huang, Ameeta Karmarkar, Brian P Barrick
We describe the case of a patient with myasthenia gravis undergoing a robotic-assisted thymectomy complicated by postoperative myasthenic crisis, with a focus on the anesthetic considerations specific to this case. Because myasthenia gravis is an autoimmune disease affecting acetylcholine receptors, caution must be taken with the use of neuromuscular blockade and reversal. Utilizing a robotic-assisted surgical approach makes anesthetic management challenging given the dangers of patient movement while the robot is docked, lung isolation, extubation criteria, and postoperative disposition...
February 3, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28151766/the-use-of-sugammadex-in-a-patient-with-guillain-barre-syndrome-a-case-report
#12
Büşra Tezcan, Demet Bölükbaş, Dilek Kazanc, Sema Turan, Gülseren Suer Kaya, Ayşegül Özgök
Sugammadex encapsulates and inactivates rocuronium and vecuronium. It is used to reverse neuromuscular blockade from these nondepolarizing agents. The safety of sugammadex in patients with neuromuscular disease has not been established. Guillain-Barre Syndrome (GBS) is a neuromuscular disease characterized by acute inflammatory polyneuropathy. Patients with GBS may exhibit autonomic dysfunction, chronic pain, abnormal reactions to neuromuscular blocking agents, and may require postoperative mechanical ventilation...
February 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28151765/necrotizing-soft-tissue-infection-or-sweet-syndrome-surgery-versus-no-surgery-a-case-report
#13
Tiffany M N Otero, Samuel R Barber, D Dante Yeh, Sadeq A Quraishi
The authors report a case of necrotizing Sweet syndrome in a 24-year-old transsexual male who presented with recurrent myonecrosis of the neck/upper chest. On index admission, computer tomography revealed gas and fat stranding of the sternocleidomastoid and pectoralis major muscle-findings suggestive of a necrotizing soft tissue infection. Despite debridement procedures and intravenous antibiotic therapy, myonecrosis of the affected areas persisted. Evaluation of tissue samples by dermatopathology revealed neutrophilic infiltration extending into the dermis and muscle necrosis, findings consistent with necrotizing Sweet syndrome...
February 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28151764/increased-resistance-to-flow-and-ventilator-failure-secondary-to-faulty-co2-absorbent-insert-not-detected-during-automated-anesthesia-machine-check-a-case-report
#14
Ingrid Moreno-Duarte, Julio Montenegro, Konstantin Balonov, Roman Schumann
Most modern anesthesia workstations provide automated checkout, which indicates the readiness of the anesthesia machine. In this case report, an anesthesia machine passed the automated machine checkout. Minutes after the induction of general anesthesia, we observed a mismatch between the selected and delivered tidal volumes in the volume auto flow mode with increased inspiratory resistance during manual ventilation. Endotracheal tube kinking, circuit obstruction, leaks, and patient-related factors were ruled out...
February 1, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28118217/postoperative-pediatric-cerebellar-mutism-after-posterior-fossa-surgery-a-case-report
#15
Jerry Y Chao, Che Liu, Naveen Shetty, Ushma Shah
Cerebellar mutism syndrome (CMS) is a common complication of posterior fossa surgery that can confound the postanesthetic examination and have long-lasting impacts. There is confusion surrounding its precise description, diagnostic features, and associated morbidity. Here, we discuss the most up-to-date knowledge of CMS drawing from a clinical case in the context of 3 new reports: (1) an international consensus paper presenting a new proposed working definition by the Iceland Delphi Group, (2) a knowledge update by Gadgil et al, (3) and a review of neuroimaging-based data elucidating the etiology of CMS by Patay...
January 23, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28118216/retropharyngeal-perforation-with-an-esophageal-dilator-a-case-report
#16
Gregory J Blair, Robert Hsiung
Esophageal "bougie" dilators are frequently used during esophageal surgeries to facilitate reconstruction and manipulation of the esophagus. Insertion of such dilators is usually a blind technique and not without risk. We present a case of retropharyngeal wall perforation resulting from esophageal dilator misplacement in a patient undergoing laparoscopic Heller myotomy and reconstruction. This case report demonstrates the importance of communication between surgery and anesthesiology teams during placement of devices into the oropharynx...
January 23, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28118215/angiovac-suction-thrombectomy-complicated-by-thrombus-fragmentation-and-distal-embolization-leading-to-hemodynamic-collapse-a-case-report
#17
Timothy Del Rosario, Mafdy Basta, Shvetank Agarwal
A 35-year-old morbidly obese woman with a history of deep vein thrombosis and pulmonary embolism presented for right atrial thrombectomy via AngioVac suction system. A portion of the thrombus could not be suctioned into the AngioVac cannula, leading to fragmentation and distal embolization with hemodynamic collapse. This sequence, observed in real time under transesophageal echocardiography, also demonstrated that the clot had echocardiographic features of chronicity. A well-organized chronic clot may be more difficult to extract via this method, leading to the complication described...
January 23, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28118214/pectoral-nerve-and-transverse-abdominis-plane-block-in-a-patient-undergoing-mastectomy-with-transverse-rectus-abdominis-muscle-flap-a-case-report
#18
Sephalie Y Patel, Raymond M Evans, Rosemarie E Garcia Getting, Pilar Suz
Postoperative nausea, vomiting, and pain present considerable concerns after reconstructive breast surgery. We present a case report of a 65-year-old woman with a history of severe postoperative nausea and vomiting, presenting for unilateral mastectomy with transverse rectus abdominis muscle flap. We performed unilateral pectoral nerve block and transverse abdominis plane block, which provided 24 hours of pain control and mitigated nausea and vomiting during the postoperative period.
January 23, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28118213/a-case-report-subanesthetic-ketamine-infusion-for-treatment-of-cancer-related-pain-produces-urinary-urge-incontinence
#19
Barbara A Vickers, Wayne Lee, Joann Hunsberger
Oncology patients undergoing treatment can experience substantial pain related to their disease or prescribed therapy. Ketamine infusions at subanesthetic doses have been used at our institution to supplement the pain management regimens of 262 patients. We present 2 cases in which young adult patients being treated with subanesthetic ketamine for cancer-related pain experienced urinary urgency and incontinence after initiation or increase of the ketamine infusion. This adverse effect has not been reported previously at this dosing range...
January 23, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28118212/delayed-anaphylaxis-to-mammalian-meat-following-tick-exposure-and-its-impact-on-anesthetic-management-for-cardiac-surgery-a-case-report
#20
Amanda M Kleiman, Keith E Littlewood, Danja S Groves
Hypersensitivity reactions to mammalian meat following tick exposure are increasing in prevalence and provide a unique challenge to anesthesiologists. The reactions, including anaphylaxis, are delayed and therefore may not be easily recognized and treated. The risk is especially high in cardiac surgery, where several potential triggers, including biological valves as well as heparin, are used frequently. In the presence of such hypersensitivity, prophylactic measures including preoperative testing and pharmacologic prophylaxis may be useful in modulating the immune response such that triggering agents may be used relatively safely...
January 23, 2017: A & A Case Reports
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