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A & A Case Reports

James K Kim, Van Nguyen
We report the successful use of peripheral nerve blocks for provision of surgical anesthesia for knee surgery in a patient who had end-stage heart failure, who was supported by a HeartMate II left ventricular assist device, and who was anticoagulated. We discuss the anesthetic implications involved in the care of patients being anticoagulated and on left ventricular assist device.
December 28, 2017: A & A Case Reports
Martina Richtsfeld, Mojca Konia, Gurumurthy Hiremath, Benjamin Kloesel
Conjoined twins are uncommon with reported incidences of 1 in 30,000-200,000 births. They represent a heterogeneous population in regard to location of joint body parts and presence/extent of internal organ fusion. Positioning, airway management, possible presence of cross-circulation, and the fact that 2 patients require anesthesia for each procedure present significant challenges to the anesthesiologist. We report the anesthetic care of a conjoined twin set in which one of the patients presented with tricuspid atresia, d-transposition of the great arteries, and both atrial and ventricular septal defect...
December 28, 2017: A & A Case Reports
Todd E Jones, Jean E Cibula, Don Bohannon, Christoph N Seubert
Not everything that shakes is an epileptic seizure. We present a patient who repeatedly exhibited severe shaking at emergence from general anesthesia. Her nonepileptic myoclonus was mistaken for a refractory seizure and treated with benzodiazepines and intravenous anesthetics. The resulting depressed level of consciousness rendered myoclonus clinically indistinguishable from refractory seizures. Over the course of 6 procedures, we found that levetiracetam, a first-line antiepileptic drug, effectively suppressed her myoclonus...
December 28, 2017: A & A Case Reports
Masakazu Kotoda, Takeshi Oguchi, Ayasa Takamino, Keiichi Wada, Takashi Matsukawa
A 62-year-old male patient suddenly developed severe dyspnea due to bilateral vocal cord paralysis (VCP) 4 days after an abdominal surgery. Emergent tracheostomy effectively improved the patient's respiratory status. The present case report emphasizes that bilateral VCP could occur even several days after an abdominal surgery in patients with multiple risk factors, such as hypertension, diabetes mellitus, an older age, male sex, and an upper abdominal surgery. Even if the patient does not present with hoarseness, bilateral VCP should not be ruled out, because a slight phonetic change can be the only symptom of early-stage bilateral VCP...
December 28, 2017: A & A Case Reports
Preethy J Mathew, Aakriti Gupta, Vinodh Natarajan, Rajarajan Ganesan, Ramesh Sharma
We present the perioperative details of a 2-year-old child scheduled for cleft palate repair. Low pulse oximetry readings after induction of anesthesia and before surgery led to the diagnosis of HbMIwate, a rare congenital methemoglobinemia due to mutation in the α-globin gene. We explored the utility of noninvasive cooximetry to monitor methemoglobin and oxygenation during anesthesia and found that noninvasive cooximetry is not useful to monitor oxygenation or to detect the percentage of methemoglobin arising from congenital variants like HbMIwate...
December 28, 2017: A & A Case Reports
Stephen J D'Amato, Maureen A Mealy, Michael A Erdek, Sharon Kozachik, Thomas J Smith
Central pain syndromes affect several million people worldwide. A 52-year-old woman had central pain manifest as burning pain from her left foot to the knee for 12 years after treatment for a medullary cavernoma diagnosed after a right-sided brainstem bleeding episode. All this time, her baseline pain was 5-6/10 with spikes to 9-10/10 during activity. She underwent 10 daily Scrambler (Calmare) Therapy treatments (GEOMC, Inc, Seoul, Korea) with reduction in her pain from 9-10/10 to 0-0.5/10, then 5 more sessions a month later...
December 28, 2017: A & A Case Reports
Victor Liu, Edward R Mariano, Christopher Prabhakar
Sternotomy pain is a common complication after cardiac surgery. We present a 77-year-old patient with severe acute sternal pain after coronary artery bypass graft surgery who was successfully treated with a novel peripheral regional anesthetic technique, the pecto-intercostal fascial block. This interfascial plane block may represent an effective regional anesthetic component of a multimodal analgesic strategy for cardiac surgery patients who suffer from significant pain after a median sternotomy and are typically anticoagulated...
December 28, 2017: A & A Case Reports
Alec Peniche, Lawrence Poree, Mark Schumacher, Xiaobing Yu
Intrathecal patient-controlled analgesia (IT-PCA) through implanted intrathecal infusion pumps has been increasingly utilized for severe cancer and chronic noncancer pain management. However, its application for acute postoperative pain management has not been reported to date. We present a case of a patient with an implanted intrathecal pump for chronic nonmalignant back pain who underwent an extensive spinal fusion surgery. The IT-PCA functionality of her intrathecal pump was successfully integrated into her postoperative multimodal pain regimen...
December 11, 2017: A & A Case Reports
Youngok J Park, Priti G Dalal, Monique Mostert, Tracy Fausnight
Flavoring a facemask with a lip balm for inhalational induction in children is a common practice. However, most anesthesia providers are unaware of potential complications and the management of allergic reactions caused by lip balm. We describe the occurrence of allergic reaction to lip balm-flavored facemask in a child who underwent an inhalational anesthetic induction. The facial rash resolved completely without complications after administration of an antihistamine and steroid.This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4...
December 11, 2017: A & A Case Reports
Matthew N P Vogt, Adam W Amundson, Julie K Heimbach, David P Martin
Intracardiac thrombus occurs in 1.2%-6.3% of patients undergoing orthotopic liver transplant and is associated with a high mortality rate. The pathophysiology and risk factors for development of this complication are not well understood. No consensus treatment guidelines exist, and specific therapies are associated with serious risks. We present the timely and successful use of a Poole tip surgical suction device advanced into the right atrium through a cavotomy created in the inferior vena cava to remove a large right atrial thrombus during liver transplant...
December 11, 2017: A & A Case Reports
Pierre-Alexis Lépine, Jean-François Naud, Philippe Boisvert
A 62-year-old man presented to the emergency department with massive hemoptysis. After bronchial artery embolization, he developed ischemic myelitis, a rare complication in this setting for which no specific therapy is currently recommended. The symptoms were managed with lumbar drainage of cerebrospinal fluid and blood pressure augmentation therapy. To our knowledge, this is the first report of using lumbar drainage of cerebrospinal fluid and blood pressure augmentation in the treatment of anterior medullary ischemia after bronchial artery embolization for massive hemoptysis...
December 11, 2017: A & A Case Reports
Michael O'Rourke, Emily S Schmidt, Jonathan E Metry, Michael B Majewski
Pain control after open abdominal surgery often includes multimodal analgesia with thoracic epidural or transversus abdominis plane (TAP) block. After liposomal bupivacaine was approved for TAP blocks in 2015, it became an alternative to indwelling catheters. However, the pharmacokinetics and safety of its use during the perioperative period have not been thoroughly investigated, especially in conjunction with parenteral opioids. We present a case report of an elderly patient having urgent laparoscopic converted to open abdominal surgery, who experienced postoperative respiratory depression in the recovery room after multimodal therapy with liposomal bupivacaine TAP blocks, intravenous (IV) opioids, and ketorolac...
November 30, 2017: A & A Case Reports
Victoria A Bradford, Ricardo J Falcon, Timothy R Petersen, Codruta N Soneru
We present a rare case of a 7-month-old infant who developed a pseudomeningocele 16 days after an uneventful caudal catheter placement. The patient did not exhibit neurological deficits or signs of infection, and the mass increased in size with Valsalva maneuver. Pseudomeningocele, an abnormal collection of cerebrospinal fluid around an opening in the dura mater, can be iatrogenic or traumatic. Regional anesthesia is rarely the cause. Recognizing diagnostic features such as the lack of infectious signs and mass compressibility can prevent misdiagnosis and inappropriate invasive treatment...
November 30, 2017: A & A Case Reports
Osama Hafez, Robert S Ackerman, Trip Evans, Sephalie Y Patel, Devang M Padalia
High dose rate interstitial brachytherapy is a commonly performed procedure for carcinoma of the lower lip. Placement of the brachytherapy catheters can be painful and may require monitored anesthesia care or general anesthesia. We present the use of bilateral mental nerve blocks with minimal sedation to facilitate placement of brachytherapy catheters.
November 30, 2017: A & A Case Reports
Iman A Hadaya, Andrew T Gray, Matthias R Braehler
A patient with end-stage amyotrophic lateral sclerosis (ALS) presented for Baclofen pump replacement. She underwent a left transversus abdominis plane block to anesthetize the left lower quadrant of the abdomen. No sedatives or analgesics were administered, and the procedure was successfully completed without complication. It is prudent to consider anesthetic plans that avoid complications associated with general or neuraxial anesthesia in patients with ALS. This case report demonstrates successful placement of a transversus abdominis plane block in a patient with ALS and offers a safe anesthetic technique that can be performed in other high-risk patients...
November 27, 2017: A & A Case Reports
Angela M Johnson, James L Hill, Dave J Zagorski, Joseph M McClain, Nicole C Maronian
Rapid sequence induction and intubation was performed for a patient in respiratory distress after a gunshot wound to the neck. Resistance was noted distal to vocal cords. With a bronchoscope unavailable, the endotracheal tube was advanced with a corkscrew maneuver. Subcutaneous emphysema had developed. The endotracheal tube was advanced into the right mainstem with adequate ventilation. Imaging illustrated tracheoesophageal injury. The patient was emergently explored. An intraluminal bullet was removed, lateral wall tracheal defect was repaired, and a tracheostomy was placed...
November 27, 2017: A & A Case Reports
Alex K Saltzman, Peter J Fu, Brian Egan
Permanent pacemakers are used for a variety of conditions and are commonly encountered in the perioperative period. This report describes the anesthetic management of a patient with a permanent pacemaker with a rate drop response (RDR) who presented for a laparoscopic left adrenalectomy. The RDR setting is a novel pacemaker mode often used in patients with a history of vasovagal syncope. There are no previous reports describing the anesthetic management of such a pacemaker. This case report describes the features of the RDR setting with the goal of educating clinicians who may encounter patients with this type of pacemaker...
November 27, 2017: A & A Case Reports
Smita Prakash, Parul Mullick, Ajay Kumar, Mridula Pawar
Drug error is a significant hazard to patient health. Poor, incorrect, and inconsistent labeling of injectable medicines and fluids, and the devices used to deliver these, has been identified as a patient safety issue. We report 5 cases of medication error as a consequence of incorrect or inappropriate labeling and analyze their cause. Recommendations for safe and practical labeling practices in anesthesia based on a review of the literature are presented. Implementation of the recommended labeling practices can reduce the risk of medication error and contribute to the safe administration of drugs...
November 27, 2017: A & A Case Reports
Peter Juhl-Olsen, Rasmus Aagaard, Anni Nørgaard Jeppesen
Point-of-care ultrasound may elucidate reversible causes of cardiac arrest, and its use is supported by international guidelines in the periarrest setting. We present a case in which the treatment of cardiac arrest caused tension pneumothoraces and cardiac tamponade by pneumopericardium. Both pneumothorax and tamponade were expected to be identified with ultrasound, but were not. Subcutaneous emphysema precluded the diagnosis of pneumothorax. Cardiac imaging was false negative for tamponade, because the latter was caused by air and not fluid...
November 27, 2017: A & A Case Reports
Janice Y Man, John E Fiadjoe, Grace Hsu
Managing the airway of an infant with Pierre Robin sequence (PRS) is particularly challenging for anesthesiologists. Patients with PRS have the triad of micrognathia, glossoptosis, and airway obstruction that potentially and frequently leads to difficulty with both ventilation and intubation. Thus continuous oxygenation and spontaneous ventilation during intubation are essential. We describe a new method to deliver continuous oxygen and volatile anesthetic during nasotracheal intubation in an infant with PRS...
November 27, 2017: A & A Case Reports
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