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A & A Case Reports

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https://www.readbyqxmd.com/read/28727597/bilateral-continuous-erector-spinae-plane-block-contributes-to-effective-postoperative-analgesia-after-major-open-abdominal-surgery-a-case-report
#1
Carlos Eduardo Restrepo-Garces, Ki Jinn Chin, Patricia Suarez, Alejandro Diaz
The erector spinae plane (ESP) block is a regional anesthetic technique involving local anesthetic injection in a paraspinal plane deep to the erector spinae muscle. Originally described for thoracic analgesia when performed at the T5 transverse process, the ESP block can provide abdominal analgesia if performed at lower thoracic levels because the erector spinae muscles extend to the lumbar spine. A catheter inserted into this plane can extend analgesic duration and can be an alternative to epidural analgesia...
July 19, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28727596/intraoperative-acute-multivessel-coronary-vasospasm-in-cardiac-allograft-a-case-report
#2
Richard Sheu, Kathleen Berfield, Stephanie Jones, Jay Pal, G Burkhard Mackensen
We present a patient who developed acute intraoperative cardiac failure requiring open cardiac message immediately after uncomplicated heart transplantation. After successful resuscitation and establishment of extracorporeal membrane oxygenation, coronary angiography showed diffuse multivessel coronary vasospasm, which responded to intracoronary and IV administration of vasodilators. Cardiac function gradually improved and the patient was discharged home after a prolonged hospital course. Cardiac allograft dysfunction associated with coronary vasospasm immediately after heart transplantation has not previously been reported...
July 19, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28719384/anesthetic-management-of-an-infant-with-postnatally-diagnosed-tracheal-agenesis-undergoing-tracheal-reconstruction-a-case-report
#3
Brittany L Willer, Kayla G Bryan, Daiva E Parakininkas, Michael R Uhing, Susan R Staudt, Kathleen M Dominguez, Michael E McCormick, Michael E Mitchell, John C Densmore, Keith T Oldham, Richard J Berens
A term infant born cyanotic failed multiple intubation attempts and tracheostomy placement. After esophageal intubation resulted in the ability to ventilate, he was presumed to have tracheal agenesis and distal bronchoesophageal fistula. He was transferred to our institution where he was diagnosed with Floyd Type II tracheal agenesis. He underwent staged tracheal reconstruction. He was discharged to home at 4 months of age with a tracheostomy collar, cervical spit fistula, and gastrostomy tube. He represents the sole survivor-to-discharge of tracheal agenesis in the United States...
July 17, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28719383/closed-loop-control-of-total-intravenous-anesthesia-during-significant-intraoperative-blood-loss-a-case-report
#4
Sonia M Brodie, Matthias Görges, J Mark Ansermino, Guy A Dumont, Richard N Merchant
Closed-loop control of anesthesia based on continuous feedback from processed electroencephalography adjusts drug dosing to target a desired depth of hypnosis during dynamic clinical circumstances, freeing the anesthesiologist to focus on more complex tasks. We describe a case of closed-loop control of total intravenous anesthesia in which a sudden loss of blood required immediate intervention. This case illustrates that closed-loop control of drug delivery maintained an appropriate depth of hypnosis during a rapidly changing surgical situation, and that processed electroencephalography may be a useful adjunct indicator for cerebral hypoperfusion...
July 17, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28719382/in-response
#5
John A C Murdoch, Yuri Koumpan, Jason A Beyea, Michael Khan, Jaime Colbeck
No abstract text is available yet for this article.
July 17, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28708629/successful-assessment-of-vocal-cord-palsy-before-tracheal-extubation-by-laryngeal-ultrasonography-in-a-patient-after-esophageal-surgery-a-case-report
#6
Natsuhiro Yamamoto, Yoshikazu Yamaguchi, Takeshi Nomura, Osamu Yamaguchi, Takahisa Goto
Laryngeal ultrasonography has mainly been performed after tracheal extubation. However, improvements in ultrasound technology now allow assessment of vocal cord function even under conditions of endotracheal intubation. We report herein the use of laryngeal ultrasonography in an endotracheally intubated patient after esophagectomy, which allowed us to make the presumptive diagnosis of bilateral recurrent nerve palsy before tracheal extubation. Our experience suggests that laryngeal ultrasonography may be useful in assessing vocal cord function even in endotracheally intubated patients, although the indications and efficacy remain to be determined...
July 13, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28697034/iatrogenic-endotracheal-tube-obstruction-by-tegaderm
#7
Lance S Patak
No abstract text is available yet for this article.
July 10, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28697033/ventricular-perforation-during-open-surgical-balloon-expandable-mitral-valve-replacement-a-case-report
#8
Yousef M Hamdeh, Jordan E Goldhammer, Nicholas J Ruggiero, John W Entwistle
A 79-year-old woman with severe mitral annular calcification was scheduled for mitral valve replacement. A SAPIEN 3 valve was implanted in mitral position using an open surgical approach. Immediately after cardiopulmonary bypass, bleeding from an unidentified source was encountered. Cardiopulmonary bypass was emergently resumed and a laceration of the left ventricular apex due to the valve delivery system was detected. Risk factors specific to the open surgical approach include a decompressed ventricle, decreased annulus to apical distance, and the absence of continuous fluoroscopic and echocardiographic imaging...
July 10, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28697032/genicular-radiofrequency-ablation-for-treatment-of-post-total-knee-arthroplasty-posterior-thigh-pain-a-case-report
#9
Lauren N Sylvester, Johnathan H Goree
We present a case of a 68-year-old woman with 6 months of chronic unilateral posterior thigh pain after a total knee arthroplasty. The patient's pain was refractory to various treatments. After appropriate diagnostic tests, a genicular nerve block and subsequent radiofrequency ablation were performed. These procedures provided substantial pain relief of her thigh pain at 3 months follow-up.
July 10, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28697031/epidural-injections-contraindicated-for-lumbar-radiculopathy-in-may-thurner-syndrome-a-case-report
#10
Michael Sniderman
A 59-year-old patient presented to the chronic pain clinic with a 6-week history of worsening lumbar back pain, bilateral thigh pain, and unilateral radiculopathy. Magnetic resonance imaging revealed mild discogenic and facetogenic disease, but significant epidural venous plexus engorgement compressing the thecal sac. The patient reported previous treatment by a vascular surgeon for May-Thurner Syndrome, a type of inferior vena caval obstruction, yet had not experienced these specific complaints. A discussion with the radiologist confirmed worsening of the patient's May-Thurner Syndrome was the likely cause of the patient's symptoms...
July 10, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28697030/severe-postpartum-headache-and-hypertension-caused-by-reversible-cerebral-vasoconstriction-syndrome-a-case-report
#11
Ed McIlroy, Rajamani Sethuraman, Reshma Woograsingh, Catherine Nelson-Piercy, Edward Gilbert-Kawai
Reversible cerebrovascular vasoconstriction syndrome is an uncommon condition that presents as severe headache and hypertension. Recent literature suggests a 1% incidence in postpartum headache cases. It can cause subarachnoid hemorrhages, cerebral ischemia, and seizures. It is often misdiagnosed as postdural puncture headache or preeclampsia. In this case, a postpartum woman, who had received epidural anesthesia for labor, presented 5 days postpartum with severe headache that did not resolve with an epidural blood patch...
July 10, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28697029/malignant-hyperthermia-in-a-morbidly-obese-patient-depletes-community-dantrolene-resources-a-case-report
#12
Fabio Magistris, Jonathan Gamble
During resection of a duodenal carcinoid tumor, a 28-year-old morbidly obese woman developed suspected malignant hyperthermia. This hypermetabolic state posed a diagnostic challenge given the similar intraoperative presentation of carcinoid crisis and malignant hyperthermia. The patient's weight posed therapeutic challenges as massive doses and prolonged administration of dantrolene were required that quickly depleted the available supply. Current dantrolene dosing recommendations are based on actual body weight despite a paucity of literature in obese patients...
July 10, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28697028/sciatic-popliteal-fossa-catheter-for-pediatric-pain-management-of-sickle-cell-crisis-a-case-report
#13
Garret Weber, Sherry Liao, Micah Alexander Burns
Sickle cell crisis, or vaso-occlusive crisis (VOC), is a major cause of hospitalizations for adults and children with sickle cell disease, and is associated with increased morbidity and mortality. Despite prompt pharmacological treatment and multimodal pain management, acute pain during a VOC is often not adequately controlled in the pediatric population. We placed a continuous popliteal sciatic nerve block under ultrasound guidance in a pediatric patient for localized refractory pain during a VOC, resulting in improved pain control with preserved sensorimotor function...
July 10, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28691986/the-role-of-sugammadex-in-symptomatic-transient-neonatal-myasthenia-gravis-a-case-report
#14
Jamie E Rubin, Radhamangalam J Ramamurthi
We describe the case of a 3-week-old boy with pyloric stenosis who presented for laparoscopic pyloromyotomy in the setting of symptomatic transient neonatal myasthenia gravis. The patient received muscle relaxation with rocuronium, and neuromuscular blockade was successfully reversed with sugammadex with recovery guided by train-of-four monitoring. He was extubated uneventfully without complications. Because sugammadex binds directly to rocuronium rather than interfering with acetylcholine metabolism, it might provide a good option for reversal of neuromuscular blockade in transient neonatal myasthenia gravis...
July 6, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28691985/hemodynamically-directed-two-person-chest-compressions-a-case-report
#15
Michael Dorbad, Ashley Kass, Michael Marvin
Cardiopulmonary resuscitation has a low success rate both in and out of the hospital setting. Return of spontaneous circulation, however, is considerably higher for intraoperative cardiac arrests. Chest compressions remain of utmost importance. Optimal chest compression depth is believed to be greater than 5 cm. However, this depth is often not achieved. We describe a case in which the adequacy of chest compressions, based on hemodynamic monitoring, was achieved with 2 persons simultaneously providing a compressive force...
July 6, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28691984/stepwise-rostrocaudal-brainstem-anesthesia-as-a-complication-of-local-anesthesia-a-case-report
#16
Braden Waters, Ryan R Kroll, John Muscedere, Lysa Boissé Lomax, Jessica E Burjorjee
Iatrogenic cranial nerve palsies can rarely complicate neurosurgical, oral maxillofacial, and otolaryngological procedures. Among the most serious complications of cranial nerve palsy is upper airway obstruction, which is life threatening. We present a case of multiple cranial nerve palsies evolving rapidly in a rostrocaudal stepwise fashion after infiltration of lidocaine to repair a cerebrospinal fluid leak in a patient postoccipital craniectomy. This led to hypoxic respiratory failure requiring mechanical ventilation before resolving spontaneously...
July 6, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28691983/incorrect-diagnosis-of-type-a-aortic-dissection-attributed-to-motion-artifact-during-computed-tomographic-angiography-a-case-report
#17
Jeremy M Bennett, Bantayehu Sileshi
Early diagnosis of aortic dissection is important to reduce mortality, with surgical management representing standard treatment. Current methods of diagnosing type A aortic dissection include computed tomography angiography (CTA), magnetic resonance imaging, catheter-based arteriography, and transesophageal echocardiography. While each method has merits, there exists potential for false-positive findings. We present a case of a patient who was diagnosed with type A aortic dissection by CTA, but was found to not have an aortic dissection by transesophageal echocardiography under general anesthesia, preventing an unnecessary sternotomy...
July 6, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28691982/percutaneous-valve-in-valve-implantation-for-dysfunctional-bioprosthetic-valves-a-case-report
#18
Ting Hai, Yannis Amador, Jelliffe Jeganathan, Arash Khamooshian, Robina Matyal, Feroze Mahmood
Percutaneous valve-in-valve therapy is a life-saving procedure for patients at high risk of reoperation due to dysfunctional bioprosthetic valves. We have reviewed 3 typical cases of a valve-in-valve procedure using high-quality images to demonstrate the suitability of this method for aortic, mitral, and tricuspid positions. Three-dimensional transesophageal echocardiography combined with other modalities such as computerized tomography and fluoroscopy are key elements for anesthesia and procedural guidance, especially as immediate tools to assess valvular function and specific procedure-related complications...
July 6, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28691981/use-of-23-4-saline-in-symptomatic-vasospasm-and-cushing-s-triad-to-prevent-herniation-and-death-a-case-report
#19
Lauren M Poe, Allison M Janda, Christina F Burger, Joseph J Schlesinger
A 53-year-old woman with migraines presented with Hunt-Hess grade 5 and Fisher grade 4 subarachnoid hemorrhage with intraventricular hemorrhage. She experienced severe vasospasm requiring intra-arterial medications. Continued vasospasm and edema resulted in Cushing's triad with profound tachypnea. Three percentage saline was administered twice without improvement. Despite the general practice to wait until complete neurologic deterioration before administering 23.4% saline, it was administered on 2 separate occasions, once after the failure of the 2 boluses of 3% saline and once on the reappearance of Cushing's triad 24 hours later, and on each occasion produced overall clinical improvement...
July 6, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28691980/sudden-increase-in-etco2-during-upper-endoscopy-under-general-endotracheal-anesthesia-suggests-the-presence-of-tracheoesophageal-fistula-a-case-report
#20
Rosemarie E Garcia Getting, Cynthia L Harris
Acquired tracheoesophageal fistula is a rare and devastating complication of lung cancer. The diagnosis is typically confirmed on barium esophagram. We report a case of a patient with lung cancer status after palliative chemoradiotherapy and esophageal stenting for malignant stenosis who presented with signs and symptoms suggestive of tracheoesophageal fistula; however, no evidence of fistula was found on barium esophagram. During subsequent esophagogastroduodenoscopy, the presence of a fistula was verified by capnography, given extreme elevations in end-tidal CO2 concentrations during endoscopic CO2 insufflation...
July 6, 2017: A & A Case Reports
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