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challenging cases in anesthesiology

Tina Stopp, Michael Feichtinger, Wolfgang Eppel, Thomas M Stulnig, Peter Husslein, Christian Göbl
McArdle disease or glycogen storage disease (GSD) type V is a rare autosomal recessive inherited disorder in skeletal muscle metabolism leading to exercise intolerance, muscle cramps and in some cases to rhabdomyolysis and acute renal failure due to elevated serum myoglobin levels. Albeit the uterine smooth muscle is not affected, pregnancy and delivery can be physically strenuous and may require specific anesthesiologic care. However, data on pregnancy progress and outcome and on special implications linked to anesthesia in women with McArdle's disease is scarce, thus posing a challenge to pre- and peripartal management...
March 21, 2018: Gynecological Endocrinology
T R Grant, E H Ellinas, A O Kula, M Y Muravyeva
BACKGROUND: Parturients with abnormally adherent placentas present anesthetic challenges that include risk-stratification, management planning and resource utilization. The labor and delivery unit may be remote from the main operating room services. METHODS: Division chiefs of North American obstetric anesthesiology services were surveyed about their practices and management of parturients with an abnormally adherent placenta. RESULTS: Eighty-four of 122 chiefs, representing 103 hospital sites, responded to the survey (response rate 69%)...
February 2, 2018: International Journal of Obstetric Anesthesia
Diane M Flynn, Linda H Eaton, Honor McQuinn, Ashley Alden, Alexa R Meins, Tessa Rue, David J Tauben, Ardith Z Doorenbos
Chronic pain is a significant problem among military personnel and a priority of the military health system. The U.S. Army Surgeon General's Pain Management Task Force recommends using telehealth capabilities to enhance pain management. This article describes the development and evaluation of a telehealth intervention (TelePain) designed to improve access to pain specialist consultation in the military health system. The study uses a wait-list controlled clinical trial to test: 1) effectiveness of the intervention, and 2) interviews to assess barriers and facilitators of the intervention implementation...
December 2017: Contemporary Clinical Trials Communications
Vitória Piai, Sandra H Vos, Reinhard Idelberger, Pauline Gans, Jonne Doorduin, Mark Ter Laan
Objective: We report the case of a professional violin player who underwent an awake craniotomy to resect a tumor in the left supplementary motor area, an area involved in motor planning. Method: A careful pre- and intraoperative monitoring plan for music performance and complex motor function was established that could be used in combination with cortical stimulation. Results: The patient suffered an epileptic seizure during cortical stimulation...
February 27, 2018: Archives of Clinical Neuropsychology: the Official Journal of the National Academy of Neuropsychologists
Michael H Andreae, Jonah S Gabry, Ben Goodrich, Robert S White, Charles Hall
BACKGROUND: US health care disparities persist despite repeated countermeasures. Research identified race, ethnicity, gender, and socioeconomic status as factors, mediated through individual provider and/or systemic biases; little research exists in anesthesiology. We investigated antiemetic prophylaxis as a surrogate marker for anesthesia quality by individual providers because antiemetics are universally available, indicated contingent on patient characteristics (gender, age, etc), but independent of comorbidities and not yet impacted by regulatory or financial constraints...
February 2018: Anesthesia and Analgesia
Juergen Konczalla, Johannes Platz, Stephan Fichtlscherer, Haitham Mutlak, Ulrich Strouhal, Volker Seifert
OBJECTIVE To date, treatment of complex unruptured intracranial aneurysms (UIAs) remains challenging. Therefore, advanced techniques are required to achieve an optimal result in treating these patients safely. In this study, the safety and efficacy of rapid ventricular pacing (RVP) to facilitate microsurgical clip reconstruction was investigated prospectively in a joined neurosurgery, anesthesiology, and cardiology study. METHODS Patients with complex UIAs were prospectively enrolled. Both the safety and efficacy of RVP were evaluated by recording cardiovascular events and outcomes of patients as well as the amount of aneurysm occlusion after the surgical clip reconstruction procedure...
August 18, 2017: Journal of Neurosurgery
S Ackermann, J Schimpf, M Richter
This article presents the case of a 6-week-old infant who, despite oral vitamin K prophylaxis and otherwise normal developmental progress, suffered a severe intracerebral and subdural hemorrhage, which required surgical evacuation. The interdisciplinary approach is described with emphasis on the management of hemostasis. Furthermore, the clinical picture of intracranial bleeding due to vitamin K deficiency, which is nowadays rare in the Western World, is described in the anesthesiology literature for the first time...
August 2017: Der Anaesthesist
Aynur Camkiran Firat, Coskun Araz, Zeynep Kayhan
STUDY OBJECTIVE: There has been a gradual decline in the number of case reports published in leading medical journals in recent years. Since case reports are not highly cited they have an adverse effect on the journal impact factor. On the other hand sharing new experiences, challenges, or discoveries with colleagues is essential for medical community. Should case reports be eliminated from the journals or published only in journals devoted to case reports? DESIGN: Observational study...
February 2017: Journal of Clinical Anesthesia
Bo Tang, Chao Zhang, Chuan Li, Jun Chen, Huaxing Luo, Dongzhu Zeng, Peiwu Yu
BACKGROUND: Robotic total mesorectal excision (RTME) for rectal cancer has recently been increasingly used; technical feasibility and short-term outcomes have been reported in detail. Few studies have presented clinical efficacy and mid-term outcomes for a large sample size. The aim of this study is to present oncologic efficacy and mid-term outcomes of robotic total mesorectal excision for rectal cancer and to provide our experiences regarding these surgically challenging issues. METHODS: Three hundred ninety-two patients received RTME between March 2010 and June 2015...
March 2017: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Michael P Leovic, Hailey N Robbins, Michael R Foley, Roman S Starikov
Management of the critically ill pregnant patient presents a clinical dilemma in which there are sparse objective data to determine the optimal setting for provision of high-quality care to these patients. This clinical scenario will continue to present a challenge for providers as the chronic illness and comorbid conditions continue to become more commonly encountered in the obstetric population. Various care models exist across a broad spectrum of facilities that are characterized by differing levels of resources; however, no studies have identified which model provides the highest level of care and patient safety while maintaining a reasonable degree of cost-effectiveness...
December 2016: American Journal of Obstetrics and Gynecology
Federico Boncagni, Luca Pecora, Vasco Durazzi, Francesco Ventrella
Williams Syndrome (WS) is a complex neurodevelopmental disorder associated with a mutation on chromosome 7. Patients with WS usually display dysmorphic facial and musculoskeletal features, congenital heart diseases, metabolic disturbances and cognitive impairment. Structural cardiovascular abnormalities are present in the majority of the children and may provide a substrate for perioperative Sudden Cardiac Death, as presented by several reports, something that creates a great challenge to the anesthetic conduct...
2016: Case Reports in Anesthesiology
Alvaro A Macias, Sunil Eappen, Ilya Malikin, Jeremy Goldfarb, Sharon Kujawa, Paul M Konowitz, Dipti Kamani, Gregory W Randolph
BACKGROUND: Although intraoperative nerve monitoring (IONM) is utilized increasingly, the information on the related anesthesia technique is limited. This study presents an up-to-date clinical algorithm, including setup and troubleshooting of an IONM system, endotracheal tube placement, and anesthetic parameters. To our knowledge, this is the first interdisciplinary collaborative protocol for monitored neck surgery based on the published evidence and clinical experience. METHODS: The Departments of Otolaryngology Head and Neck Surgery, Anesthesiology, and Audiology collaboratively developed a protocol for IONM of the recurrent laryngeal nerve (RLN) based on published evidence and our experience with 3000 patients over a 16-year period...
October 2016: Head & Neck
Anurag Aggarwal, Rohit Lohani, Varun Suresh
Video-assisted thoracoscopic surgery (VATS) in the pediatric population is a challenging task for any anesthesiologist, moreover considering the high incidence of associated congenital anomalies which are individual predictors of poor prognosis. A thorough preoperative evaluation, knowledge of the physiology of one lung ventilation - pertaining to various methods of lung isolation, individualized meticulous planning, and continuous vigilance to detect any untoward event at the earliest with good communication between the anesthesiology and surgical teams contributes to a safe and successful surgery...
January 2016: Anesthesia, Essays and Researches
Aditee P Ambardekar, Devika Singh, Justin L Lockman, David L Rodgers, Roberta L Hales, Harshad G Gurnaney, Aruna Nathan, Ellen S Deutsch
BACKGROUND: Pediatric anesthesiologists must manage crises in neonates and children with timely responses and limited margin for error. Teaching the range of relevant skills during a 12-month fellowship is challenging. An experiential simulation-based curriculum can augment acquisition of knowledge and skills. OBJECTIVES: To develop a simulation-based boot camp (BC) for novice pediatric anesthesiology fellows and assess learner perceptions of BC activities. We hypothesize that BC is feasible, not too basic, and well received by fellows...
May 2016: Paediatric Anaesthesia
Sbaraglia Fabio, Garra Rossella, De Riso Mariella, Continolo Nicola, Sammartino Maria
Anesthesiological management of patients with Takotsubo syndrome (TTS) is a challenge of questions related to physiopathology, prognosis, and trigger causes. Relative rarity of this disease and lack of wide literature do not allow to state any negative or positive effect of the variety of drugs available for anesthesia. The authors report a case of a woman with a clear diagnosis of TTS and anxiety disorder, who underwent to cataract extractions at both eyes at two different times. Clinical management is described, from preoperative assessment until discharge of the patient...
January 2016: Journal of Opioid Management
Prodromos Philippou, D Lamrani, Konstantinos Moraitis, Hassan Wazait, Junaid Masood, Noor Buchholz
PURPOSE: Shock-wave lithotripsy (SWL) for elderly patients can be challenging. Patients often have a long-standing complex stone burden and significant comorbidities. We report a cohort of patients aged ⩾70 years who were treated by SWL, with special attention to treatment outcomes, complications and the need for adjuvant procedures. PATIENTS AND METHODS: Over a period of 4 years, 2311 patients were treated with SWL in a tertiary referral centre. Among these patients, 137 were aged ⩾70 years (5...
March 2011: Arab Journal of Urology
Cecilia Maria Cracco, Peter Alken, Cesare Marco Scoffone
PURPOSE OF THE REVIEW: To highlight the progressive evolution of the issue of patient positioning for percutaneous nephrolithotomy (PNL), explain the history of the prone and supine positions, report respective advantages and drawbacks, critically interpret the past and current literature supporting such arguments, identify the best candidates for each position, and reflect on the future evolution of the two approaches. RECENT FINDINGS: Positioning for PNL has become a matter of debate during the last decade...
January 2016: Current Opinion in Urology
G Alec Rooke, Stefan A Lombaard, Gail A Van Norman, Jörg Dziersk, Krishna M Natrajan, Lyle W Larson, Jeanne E Poole
BACKGROUND: Management of cardiovascular implantable electronic devices (CIEDs), including pacemakers and implantable cardioverter defibrillators, for surgical procedures is challenging due to the increasing number of patients with CIEDs and limited availability of trained providers. At the authors' institution, a small group of anesthesiologists were trained to interrogate CIEDs, devise a management plan, and perform preoperative and postoperative programming and device testing whenever necessary...
November 2015: Anesthesiology
Pietro Spennato, Giancarlo Nicosia, Lucia Quaglietta, Vittoria Donofrio, Giuseppe Mirone, Giuliana Di Martino, Elia Guadagno, Maria Laura del Basso de Caro, Daniele Cascone, Giuseppe Cinalli
INTRODUCTION: Management of posterior fossa tumors in infants and neonates is challenging. The characteristics of the young babies make surgery very difficult, sometimes precluding a safe complete removal. METHODS: A review of the literature was undertaken to examine the incidence, histology, surgical aspects, and prognosis of posterior fossa tumors in the first year of life. Therapeutical strategies of the most frequent tumor types are also discussed in detail...
October 2015: Child's Nervous System: ChNS: Official Journal of the International Society for Pediatric Neurosurgery
Richard H Epstein, Franklin Dexter, Neil Patel
In this review article, we address issues related to using data from anesthesia information management systems (AIMS) to deliver near real-time alerts via AIMS workstation popups and/or alphanumeric pagers and post hoc reports via e-mail. We focus on reports and alerts for influencing the behavior of anesthesia providers (i.e., anesthesiologists, anesthesia residents, and nurse anesthetists). Multiple studies have shown that anesthesia clinical decision support (CDS) improves adherence to protocols and increases financial performance through facilitation of billing, regulatory, and compliance documentation; however, improved clinical outcomes have not been demonstrated...
September 2015: Anesthesia and Analgesia
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