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challenging cases in anesthesiology

https://read.qxmd.com/read/38166658/an-ambulatory-dental-treatment-of-a-child-with-rett-syndrome-and-limited-mouth-opening-under-muscle-relaxant-free-general-anesthesia-a-case-report
#21
JOURNAL ARTICLE
Xiao Tan, Bo Zhu, Yanchen Li, Yuguang Huang
BACKGROUND: Rett Syndrome (RTT) is a rare, severe, and progressive developmental disorder with intellectual disability. Anesthesia in RTT patients presents a range of challenges. We report a child with RTT who received dental treatment under muscle relaxant-free general anesthesia in our ambulatory center. CASE PRESENTATION: A 15-year-old girl with RTT was admitted to our dental clinic with multiple dental caries and residual roots. Dental treatment was scheduled under ambulatory general anesthesia...
January 2, 2024: BMC Anesthesiology
https://read.qxmd.com/read/38149150/delayed-extubation-of-a-patient-with-multiple-sclerosis
#22
Alexander Duong, Tomohiro Yamamoto, Satoshi Yamamoto
The potential complications associated with gastroparesis in the perioperative setting for patients with multiple sclerosis (MS) are inadequately recognized. While gastroparesis is commonly associated with diabetes mellitus-induced neuropathy and postsurgical complications, its prevalence and impact on patients with MS are less understood. This is particularly crucial as the systemic autoimmune nature of MS may extend its neurological effects to the gastrointestinal (GI) tract. In this context, we present a case wherein undiagnosed gastroparesis significantly contributed to postoperative challenges, leading to delayed extubation in a patient with MS...
November 2023: Curēus
https://read.qxmd.com/read/38143691/challenging-diagnosis-and-management-a-complex-case-following-an-urgent-caeserean-section
#23
Gabriela Tenreiro, Carolina Santos, Elvira Machado, Sandra Carneiro
Hemodynamic changes during pregnancy are physiological adaptations to fulfill new demands. Although these adaptations are often well-tolerated, they may unmask or exacerbate underlying cardiovascular conditions, posing unique challenges for medical professionals. We present a case that outlines the evaluation and treatment of a 38-year-old woman who experienced health complications shortly after undergoing a Caesarean section.  A 38-year-old woman who had a previous caeserean section presented for an urgent caeserean section at 39 weeks of gestational age due to non-reassuring cardiotocography...
November 2023: Curēus
https://read.qxmd.com/read/38127467/incidence-factors-and-prognostic-analyses-of-challenging-cardiopulmonary-bypass-separation-in-chinese-cardiac-surgical-populations
#24
JOURNAL ARTICLE
Dong X Chen, Tian H Wang, Xing L Xiong, Jing Shi, Leng Zhou
BACKGROUND: Challenging separation from cardiopulmonary bypass (CPB) has been associated with multiple medical adversities, while its incidence, associated factors, and prognosis among cardiac surgery populations are substantially understudied. METHODS: Adult cardiac surgical patients in two medical centers were retrospectively analyzed. Separation from CPB was stratified as easy, difficult, or complex, based on the use of pharmacologic assistance agents and mechanical supports...
December 21, 2023: Minerva Anestesiologica
https://read.qxmd.com/read/38125693/unexpected-presentation-of-tracheoesophageal-fistula-during-intubation-in-a-pediatric-patient
#25
Margarida Telo, Larissa Morais, Rodrigo Ferreira, Adelaide P Coelho, Ivanete Peixer
Tracheoesophageal fistula (TEF) is an abnormal connection between the trachea and esophagus. This report presents a rare case of a pediatric patient who developed a TEF due to battery ingestion, which was diagnosed during intubation and resulted in cardiac arrest. A 4-year-old child with a two-year history of battery ingestion presented with severe dehydration, weight loss, and recurrent respiratory tract infections. Chest X-ray revealed a radiopaque foreign body in the esophagus. During general anesthesia for central venous line insertion and after endotracheal intubation, some difficulties in ventilation occurred, characterized by the inability to reach tidal volume, absence of capnography, and stomach distention which led to hypoxia and ultimately to cardiac arrest...
December 2023: Curēus
https://read.qxmd.com/read/38109186/remimazolam-sedation-and-neuraxial-anesthesia-in-a-patient-with-amyotrophic-lateral-sclerosis-undergoing-an-open-colectomy-a-case-report
#26
JOURNAL ARTICLE
Sindhuja Nimma, Asaf Gans, Richa Wardhan, Wesley Allen
Amyotrophic lateral sclerosis (ALS) is a neurodegenerative disease involving the upper and lower motor neurons. Perioperative management of patients with ALS can be challenging due to the risk of hemodynamic instability, aspiration, and ventilatory failure. We discuss a 58-year-old male patient with ALS who underwent open abdominal surgery under regional anesthesia utilizing a remimazolam infusion for sedation. While various sedation agents have been used successfully in patients with ALS, remimazolam, a new short-acting benzodiazepine with unique pharmacologic properties and reversible anxiolysis, provides amnesia while avoiding ventilatory depression...
December 1, 2023: A&A Practice
https://read.qxmd.com/read/38088804/assessing-the-utility-of-a-machine-learning-model-to-assist-with-the-assignment-of-the-american-society-of-anesthesiology-physical-status-classification-in-pediatric-patients
#27
JOURNAL ARTICLE
Lynne R Ferrari, Izabela Leahy, Steven J Staffa, Peter Hong, Isabel Stringfellow, Jay G Berry
BACKGROUND: The American Society of Anesthesiologists Physical Status Classification System (ASA-PS) is used to classify patients' health before delivering an anesthetic. Assigning an ASA-PS Classification score to pediatric patients can be challenging due to the vast array of chronic conditions present in the pediatric population. The specific aims of this study were to (1) suggest an ASA-PS score for pediatric patients undergoing elective surgical procedures using machine-learning (ML) methods; and (2) assess the impact of presenting the suggested ASA-PS score to clinicians when making their final ASA-PS assignment...
December 8, 2023: Anesthesia and Analgesia
https://read.qxmd.com/read/38087206/ultrasound-assisted-lumbar-puncture-with-a-horizontal-and-perpendicular-paramedian-approach-based-on-positioning-in-patients-with-abnormal-spinal-anatomy-a-case-report-and-technical-description
#28
JOURNAL ARTICLE
Chanyan Huang, Jiawen Li, Yuting Guo, Yuanjia Zhang, Wei Luo, Daniel A Diedrich, Tao Zhang, Wenqi Huang, Ying Xiao
BACKGROUND: The use of ultrasound has been reported to be beneficial in challenging neuraxial procedures. The angled probe is responsible for the main limitations of previous ultrasound-assisted techniques. We developed a novel technique for challenging lumbar puncture, aiming to locate the needle entry point which allowed for a horizontal and perpendicular needle trajectory and thereby addressed the drawbacks of earlier ultrasound-assisted techniques. CASE PRESENTATION: Patient 1 was an adult patient with severe scoliosis who underwent a series of intrathecal injections of nusinersen...
December 12, 2023: BMC Anesthesiology
https://read.qxmd.com/read/38066479/giant-left-pheochromocytoma-with-vascular-anomalies-and-pelvic-horseshoe-kidney-a-case-report
#29
JOURNAL ARTICLE
Emily Biben, Lakshmi Menon, Neriman Gokden, Matthew F Spond, Joshua M Eichhorn, Ahmet Murat Aydin
BACKGROUND: Pheochromocytoma is a neuroendocrine tumor, and its treatment is dependent on surgical resection. Due to the wide availability of cross-sectional imaging, pheochromocytomas are commonly seen as small tumors less than 10 cm in size and are mostly treated with minimally invasive surgery. Their concomitant presence with horseshoe kidney or other anatomical and vascular anomalies is rare. Herein, we present a surgically complex giant pheochromocytoma case who underwent an open left radical adrenalectomy...
December 8, 2023: BMC Urology
https://read.qxmd.com/read/38031494/airway-and-respiratory-complications-during-anaesthesia-and-associated-with-peri-operative-cardiac-arrest-as-reported-to-the-7th-national-audit-project-of-the-royal-college-of-anaesthetists
#30
JOURNAL ARTICLE
T M Cook, F Oglesby, A D Kane, R A Armstrong, E Kursumovic, J Soar
The 7th National Audit Project (NAP7) of the Royal College of Anaesthetists studied complications of the airway and respiratory system during anaesthesia care including peri-operative cardiac arrest. Among 24,721 surveyed cases, airway and respiratory complications occurred commonly (n = 421 and n = 264, respectively). The most common airway complications were: laryngospasm (157, 37%); airway failure (125, 30%); and aspiration (27, 6%). Emergency front of neck airway was rare (1 in 8370, 95%CI 1 in 2296-30,519)...
April 2024: Anaesthesia
https://read.qxmd.com/read/38024007/refractory-complex-regional-pain-syndrome-a-case-report-and-review-of-literature
#31
Mahmood-Reza Alebouyeh, Seyedeh Fatemeh Morsali, Faegheh Zojaji, Seyed Ali Ebrahimi, Ali Ahani, Ali Antar
INTRODUCTION: Complex regional pain syndrome (CRPS) is characterized by extreme pain in a limb disproportional to the clinical history or physical findings accompanied by the signs of autonomic dysfunction. The pathophysiology of CRPS is obscure, making it challenging to treat. Treatment options include medications, physical therapy, and psychological support. In some cases, surgery or other minimally-invasive procedures such as nerve blocks may be recommended, while several novel treatments, such as ozone therapy, lack sufficient clinical evidence...
August 2023: Anesthesiology and Pain Medicine
https://read.qxmd.com/read/38021671/anesthetic-management-for-dental-extraction-in-a-patient-with-catecholaminergic-polymorphic-ventricular-tachycardia-syndrome-a-case-report
#32
Edmund Wang, Van N Trinh, Bradlee J Bachar, Hussam Nagm
Catecholaminergic polymorphic ventricular tachycardia (CPVT) is an inherited genetic disorder that predisposes patients to potentially fatal arrhythmia when under physical or emotional stress. Anesthetic management of patients with CPVT poses a huge challenge as physical and emotional stressors are common in the operating room. Stressors, such as pain and anxiety, must be carefully controlled to prevent life-threatening tachyarrhythmias. Currently there is a paucity of data on the anesthetic management of patients with CPVT...
October 2023: Curēus
https://read.qxmd.com/read/38021515/navigating-the-dry-tap-conundrum-a-successful-spinal-anesthesia-for-a-cesarean-section
#33
Saleh A Ba-Shammakh, Ahmad Al-Samnah, Mohammad K Zidan, Haitham M Abdallah
A "dry tap" in spinal anesthesia is characterized by the lack of cerebrospinal fluid (CSF) after needle insertion and poses unique challenges for anesthesiologists. We present an uncommon case of a 30-year-old female undergoing a cesarean section who experienced this situation. Despite the absence of CSF after several attempts, the patient's sensory alterations post-anesthesia administration confirmed intrathecal placement. This successful administration of spinal anesthesia in the face of a dry tap emphasizes the value of clinical observation and adaptability, offering an innovative perspective on addressing such rare occurrences...
October 2023: Curēus
https://read.qxmd.com/read/38021333/general-anesthesia-in-schwartz-jampel-syndrome-a-case-report
#34
Pooya Derakhshan, Azadeh Habibi, Saied Amniati
INTRODUCTION: Schwartz-Jampel syndrome (SJS) is a rare autosomal recessive disease characterized by muscle weakness and stiffness, abnormal bone development, short stature, joint contractures, and facial dysmorphisms. Myopathy, anatomical deformities, and malignant hyperthermia are challenging for anesthesiologists. CASE PRESENTATION: This case report describes one case of SJS. The female patient was scheduled for Blepharoplasty in Rasuol Akram General Hospital...
June 2023: Anesthesiology and Pain Medicine
https://read.qxmd.com/read/37994838/metabolic-crisis-in-maple-syrup-urine-disease-an-unusual-complication-of-a-rare-disease-a-case-report
#35
JOURNAL ARTICLE
Hemang P Doshi, Hemal H Vachharajani, Michael C Tchan, Mohamed A Nasreddine, Kate E Billmore
A 19-year-old woman with known maple syrup urine disease presented to hospital with metabolic crisis in the setting of influenza type A infection and intractable vomiting, rapidly progressing to acute cerebral oedema manifesting as refractory seizures and decreased level of consciousness needing emergency intubation and mechanical ventilation, continuous veno-venous haemodiafiltration and thiopentone coma. A computed tomography scan and magnetic resonance imaging of the brain demonstrated classic signs of cerebral oedema secondary to a metabolic crisis from the metabolic disorder...
January 2024: Anaesthesia and Intensive Care
https://read.qxmd.com/read/37977195/early-goal-directed-hemostatic-therapy-for-severe-acute-bleeding-management-in-the-intensive-care-unit-a-narrative-review
#36
REVIEW
Tomaz Crochemore, Klaus Görlinger, Marcus Daniel Lance
This is a narrative review of the published evidence for bleeding management in critically ill patients in different clinical settings in the intensive care unit (ICU). We aimed to describe "The Ten Steps" approach to early goal-directed hemostatic therapy (EGDHT) using point-of-care testing (POCT), coagulation factor concentrates, and hemostatic drugs, according to the individual needs of each patient. We searched National Library of Medicine, MEDLINE for publications relevant to management of critical ill bleeding patients in different settings in the ICU...
March 1, 2024: Anesthesia and Analgesia
https://read.qxmd.com/read/37948545/posterior-reversible-encephalopathy-syndrome-and-eclampsia-in-the-setting-of-magnesium-toxicity-a-case-report
#37
JOURNAL ARTICLE
Ariella T Lee, Justin C Cordova, Robert P Jamplis, Gregory R Pomicter
Posterior reversible encephalopathy syndrome (PRES) is a rare neurologic condition and a feared complication of eclampsia. It is evidenced by acute neurologic dysfunction secondary to cerebral edema and is typically reversible in nature. Although it is a relatively new diagnosis, an increasing amount of literature has described its occurrence, including an association with hypomagnesemia. We present a case wherein a 24-year-old parturient developed PRES and eclampsia in the setting of symptomatic hypermagnesemia, requiring management with lorazepam after seizures developed...
November 1, 2023: A&A Practice
https://read.qxmd.com/read/37941803/adapting-cognitive-task-analysis-methods-for-use-in-a-large-sample-simulation-study-of-high-risk-healthcare-events
#38
JOURNAL ARTICLE
Laura G Militello, Megan E Salwei, Carrie Reale, Christen Sushereba, Jason M Slagle, David Gaba, Matthew B Weinger, John Rask, Janelle Faiman, Michael Andreae, Amanda R Burden, Shilo Anders
Cognitive task analysis (CTA) methods are traditionally used to conduct small-sample, in-depth studies. In this case study, CTA methods were adapted for a large multi-site study in which 102 anesthesiologists worked through four different high-fidelity simulated high-consequence incidents. Cognitive interviews were used to elicit decision processes following each simulated incident. In this paper, we highlight three practical challenges that arose: (1) standardizing the interview techniques for use across a large, distributed team of diverse backgrounds; (2) developing effective training; and (3) developing a strategy to analyze the resulting large amount of qualitative data...
December 2023: Journal of Cognitive Engineering and Decision Making
https://read.qxmd.com/read/37938078/covid-19-infection-and-ambulatory-surgery-decision-making-based-on-known-knowns
#39
REVIEW
Leopoldo Vicente Rodriguez, Joshua Aaron Bloomstone
During the spring of 2020, as Coronavirus Disease 2019 (COVID-19) infections rapidly spread across the globe, all sectors of healthcare, everywhere, would change in ways that were unimaginable. Early on, the ambulatory surgery space, being no exception, would suffer deep and impactful reductions in patient volume and revenue. Though actual care stoppages were short-lived, decreased ambulatory surgical patient volumes continued for a myriad of reasons, though in some cases, ambulatory surgery centers (ASCs) provided surgical care in limited numbers to patients who were "offloaded" from inpatient lists...
September 2023: Best Practice & Research. Clinical Anaesthesiology
https://read.qxmd.com/read/37927632/latex-free-anesthesia-for-craniosynostosis-surgery-associated-with-xia-gibbs-syndrome-a-case-report
#40
Matheus S Nascimento, Sarah G de Paula, Thiago C Lago Alves, Bruna G Noronha, Heitor Medeiros
This case report describes the anesthetic management of a one-year-old patient with Xia-Gibbs syndrome, which is a rare genetic condition caused by a mutation in the AHDC1 gene. The procedure involved calvarial vault remodeling and fronto-orbital advancement to correct a left coronal craniosynostosis. In addition, the patient had a history of seizures and latex-fruit syndrome, which necessitated careful preoperative planning and management. Despite the difficulties provided by the patient's cranial abnormalities and the paucity of literature on anesthetic experiences with the condition, the treatment was completed successfully and without complications...
October 2023: Curēus
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