Case Reports in Anesthesiology最新文献

{"title":"Remimazolam Anesthesia for MitraClip Implantation in a Patient with Advanced Heart Failure.","authors":"Tomoe Satoh,&nbsp;Noriaki Nishihara,&nbsp;Yasuaki Sawashita,&nbsp;Sho Ohno,&nbsp;Naoyuki Hirata,&nbsp;Michiaki Yamakage","doi":"10.1155/2021/5536442","DOIUrl":"https://doi.org/10.1155/2021/5536442","url":null,"abstract":"<p><p>Remimazolam, a novel and ultrashort-acting benzodiazepine, has been available for general anesthesia in Japan. The administration of remimazolam does not induce injection pain, has been reported to have less cardiovascular depressant effects during general anesthesia, and flumazenil can antagonize the effects of remimazolam. However, in clinical trials, no patient who is complicated with severe heart failure or undergoes cardiac surgery was included. We present anesthetic management with remimazolam for MitraClip^® implantation in a patient with severe mitral regurgitation and advanced heart failure. Remimazolam was administered both in anesthetic induction and maintenance with less cardiovascular depressant effects. After surgical procedures were completed, the patient smoothly recovered from anesthesia and the tracheal was extubated just after administration of flumazenil. Remimazolam may be able to achieve appropriate anesthetic management in patients complicated with severe cardiovascular diseases.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2021 ","pages":"5536442"},"PeriodicalIF":0.0,"publicationDate":"2021-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8116154/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38936894","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of Video Laryngoscope in Sedated Spontaneously Breathing Patients with Predicted Difficult Tracheal Intubation and Impossibility of Using Fibreoptic Bronchoscopy.","authors":"Alba Piroli,&nbsp;Ida Marsili,&nbsp;Franco Marinangeli,&nbsp;Silvia Costanzi,&nbsp;Luca Gentili,&nbsp;Antonella Paladini","doi":"10.1155/2021/5524240","DOIUrl":"https://doi.org/10.1155/2021/5524240","url":null,"abstract":"<p><p>Intubation with a flexible fibrobronchoscope in an awake patient is frequently considered the technique of choice in patients with predicted difficult intubation. There are, however, situations in which the use of the fibrobronchoscope is not applicable, particularly due to problems attributable to the patient or to limited use of the instrument. In such situations, the video laryngoscope can be a useful alternative, as long as it is associated with adequate sedation of the patient. In fact, it ensures excellent viewing of the glottis, allowing for successful orotracheal intubation to be performed even in case of difficult airways, while keeping the patient spontaneously breathing throughout the procedure. From the data present in the literature, this technique seems to ensure a success rate and a safety profile similar to those obtained with the fibrobronchoscope, moreover, with greater ease of use by the anaesthesiologist. The main purpose of this work is to provide a valid and safe alternative to intubation with a fibrobronchoscope while awake in those patients with anticipated difficult airway management and in whom, for different reasons, fibrobronchoscope cannot be used.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2021 ","pages":"5524240"},"PeriodicalIF":0.0,"publicationDate":"2021-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8102116/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39008402","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Management of a Patient with Intraoperative Bleeding of More than 80,000 mL and Usefulness of QTc Monitoring for Calcium Correction.","authors":"Yuki Sugiyama,&nbsp;Kazuma Aiba,&nbsp;Nariaki Arai,&nbsp;Mariko Ito,&nbsp;Masatoshi Urasawa,&nbsp;Chie Hirose,&nbsp;Ikuko Murakami,&nbsp;Ryusuke Tanaka,&nbsp;Tomokatsu Yamada,&nbsp;Keisuke Iida,&nbsp;Hiroyuki Nakamura,&nbsp;Mikito Kawamata","doi":"10.1155/2021/6635696","DOIUrl":"https://doi.org/10.1155/2021/6635696","url":null,"abstract":"<p><p>Intraoperative massive bleeding is associated with high rates of mortality and anesthetic management of massive bleeding is challenging because it is necessary to achieve volume resuscitation and electrolyte correction simultaneously during massive transfusion. We report a case of life-threatening bleeding of more than 80,000 mL during liver transplantation in which real-time QTc monitoring was useful for an extremely large amount of calcium administration for treatment of hypocalcemia. A 47-year-old female with a giant liver due to polycystic liver disease was scheduled to undergo liver transplantation. During surgery, life-threatening massive bleeding occurred. The maximum rate of blood loss was approximately 15,000 mL/hr and the total amount of estimated blood loss was 81,600 mL. It was extremely difficult to maintain blood pressure and a risk of cardiac arrest continued due to hypotension. In addition, even though administration of insulin and calcium was performed, electrolyte disturbances of hyperkalemia and hypocalcemia with prolongation of QTc interval occurred. At that time, we visually noticed that the QT interval was shortened in response to bolus calcium administration, and we used the change of real-time QTc interval as a supportive indicator for calcium correction. This monitoring allowed for us to administer calcium at an unusually high rate, by which progression of hypocalcemia was prevented. Levels of hemoglobin and coagulation factors were preserved both by restriction of crystalloid infusion and by a massive transfusion protocol. The patient was extubated without pulmonary edema or cardiac overload and was finally discharged without any sequelae. Intensive and cooperative management for massive transfusion and electrolyte correction using QTc monitoring was considered to be a key for successful management.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2021 ","pages":"6635696"},"PeriodicalIF":0.0,"publicationDate":"2021-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8062170/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38940529","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous Spinal Anaesthesia for Intertrochanteric Femur Fracture in a Patient with Skeletal Dysplasia.","authors":"Sharad Khakurel,&nbsp;Rupesh Kumar Yadav","doi":"10.1155/2021/6644894","DOIUrl":"https://doi.org/10.1155/2021/6644894","url":null,"abstract":"<p><p>The practice of continuous spinal anaesthesia is not common. Though underutilised, it offers significant advantage when compared to the single-shot technique nonetheless. Time and again, it has proven its worth in patients with advanced cardiac illness, spinal deformities, and obesity. We here successfully employed this neuraxial anaesthetic technique in a sixty-two-year-old male patient with skeletal dysplasia, who presented for surgical fixation of intertrochanteric fracture of the femur. With short stature, anticipated difficult airway, and poor pulmonary status complicating the anaesthetic plan, we opted for continuous spinal anaesthesia. The procedure was carried out uneventfully with 8 mg of hyperbaric bupivacaine used in titration to anaesthetic needs. Patients with skeletal dysplasia present with wide array of clinical conditions that pose a formidable challenge to anaesthesiologists. Continuous spinal anaesthesia can be safely practiced in such patients as it provides a titratable form of neuraxial blockade with reduced dose of local anaesthesia. This, in turn, ensures a predictable block and, thus, hemodynamic stability.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2021 ","pages":"6644894"},"PeriodicalIF":0.0,"publicationDate":"2021-04-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8057902/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38954425","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Management of Anaesthesia for a High-Risk Aerosol-Generating Procedure in a Paediatric Patient with COVID-19.","authors":"Gezy Giwangkancana,&nbsp;Ezra Oktaliansyah,&nbsp;R Ayu Hardianti Saputri","doi":"10.1155/2021/5568725","DOIUrl":"https://doi.org/10.1155/2021/5568725","url":null,"abstract":"<p><strong>Introduction: </strong>Paediatric patients represent a small portion of the COVID-19 disease population. Nevertheless, the possibility of a paediatric patient requiring surgery, especially high-risk aerosol-generating surgery on the airway, while having the SARS-CoV-2 infection may potentially result in problems during the perioperative period due to concerns regarding patient, family, and staff safety. When unplanned and unrehearsed, this scenario may cause delays and efficiency issues. Our aim is to report on an 8-year-old patient with a foreign object lodged in the oesophagus with COVID-19 that required emergency surgery. <i>Case Report</i>. An 8-year-old female patient came to the emergency room with a history of difficulty in swallowing for 12 hours before admission, having accidentally swallowed a metal coin while playing. She did not have any recent history of disease, but her parents had noticed that, for the previous 4 days, she had had a mild fever and dry cough. Her parents and other relatives in the house had no similar complaints, and they assured us they had not been in contact with any suspected or confirmed COVID-19 patients. Our goal was to create a safe paediatric anaesthesia environment with safe working conditions for the surgical team. In this case report, we will describe our approach to patient transport, parental presence, preventions of aerosol risk, personal protection, the anaesthesia induction technique, and postoperative management.</p><p><strong>Conclusion: </strong>Safe paediatric anaesthesia, especially in a high-risk aerosol-generating procedure, during the COVID-19 era requires consideration and preparation of both the patient and healthcare provider. Multidisciplinary team work with an emphasis on a systematic and planned approach is required to improve efficiency.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2021 ","pages":"5568725"},"PeriodicalIF":0.0,"publicationDate":"2021-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7986487/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25536642","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel Use of Liposomal Bupivacaine in Erector Spinae Plane Block for Pediatric Congenital Cardiac Surgery.","authors":"Stylianos Voulgarelis,&nbsp;Gregory M Halenda,&nbsp;Justinn M Tanem","doi":"10.1155/2021/5521136","DOIUrl":"https://doi.org/10.1155/2021/5521136","url":null,"abstract":"<p><p>We describe the use of liposomal bupivacaine (Exparel) in erector spinae plane blocks for two patients undergoing pediatric cardiac surgery with cardiopulmonary bypass and one undergoing division of the compressive vascular ring. The perioperative course of all patients was remarkable for low pain and sedation scores, especially after chest tube removal. Erector spinae plane blocks are an expanding pain-control technique in both adult and pediatric cardiac surgery for postoperative analgesia. Liposomal bupivacaine offers prolonged analgesia and may be an attractive option for this indication.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2021 ","pages":"5521136"},"PeriodicalIF":0.0,"publicationDate":"2021-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7981172/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25525086","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous Spinal Anesthesia following Inadvertent Dural Puncture during Epidural Placement for an Emergency Laparotomy.","authors":"Andrew Emyedu,&nbsp;Bernadette Kyoheirwe,&nbsp;Patience Atumanya","doi":"10.1155/2021/8819864","DOIUrl":"https://doi.org/10.1155/2021/8819864","url":null,"abstract":"<p><p><i>Summary</i>. Emergency exploratory laparotomy conducted under continuous spinal anesthesia using a standard epidural set following an accidental dural puncture. <i>Background and Objectives</i>. Continuous spinal anesthesia is one of the least utilized regional anesthesia techniques globally. It could be an alternative anesthesia technique for abdominal and lower limb surgeries following an accidental dural puncture. The aim of this report was to describe a case in which continuous spinal anesthesia was successfully conducted for emergency exploratory laparotomy following an accidental dural puncture during epidural placement. <i>Case Report</i>. A 38-year-old male presented to our accident and emergency unit with a one-day history of colicky abdominal pain associated with constipation, abdominal distension, and vomiting. He was diagnosed with intestinal obstruction and underwent an emergency exploratory laparotomy under continuous spinal anesthesia using a standard epidural set following an accidental dural puncture. <i>Conclusion</i>. This case demonstrates that in case of an accidental dural puncture during epidural placement, the catheter can be advanced into the intrathecal space and continuous spinal anesthesia conducted for abdominal surgeries using a standard epidural catheter.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2021 ","pages":"8819864"},"PeriodicalIF":0.0,"publicationDate":"2021-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7960041/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25501180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Successful Anesthesia Management of Postoperative Maternal Pulmonary Edema and Uterine Hyperactivity following Open Fetal Myelomeningocele Repair.","authors":"Denis Snegovskikh,&nbsp;Konstantina Svokos,&nbsp;Dmitri Souza,&nbsp;Elizabeth Renaud,&nbsp;Stephen R Carr,&nbsp;Mark C Kendall,&nbsp;Francois I Luks","doi":"10.1155/2021/6679845","DOIUrl":"https://doi.org/10.1155/2021/6679845","url":null,"abstract":"<p><p>Effective tocolysis is essential after fetal myelomeningocele repair and is associated with the development of pulmonary edema. The increased uterine activity in the immediate postoperative period is commonly treated with magnesium sulfate. However, other tocolytic agents such as nitroglycerine, nifedipine, indomethacin, terbutaline, and atosiban (outside the US) have also been used to combat uterine contractility. The ideal tocolytic regimen which balances the risks and benefits of in-utero surgery has yet to be determined. In this case report, we describe a unique case of fetal myelomeningocele repair complicated by maternal pulmonary edema and increased uterine activity resistant to magnesium sulfate therapy.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2021 ","pages":"6679845"},"PeriodicalIF":0.0,"publicationDate":"2021-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7954628/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25501179","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Continuous Erector Spinae Plane Block for Analgesia after Thoracotomy for Lung Transplantation in an Anticoagulated Patient.","authors":"Mark Mudarth,&nbsp;Veena Satyapriya,&nbsp;John Coffman,&nbsp;Peter DeSocio,&nbsp;Alec Lawrence,&nbsp;Shana Schwartz,&nbsp;Michael Kushelev","doi":"10.1155/2021/6664712","DOIUrl":"https://doi.org/10.1155/2021/6664712","url":null,"abstract":"<p><p>Lung transplant recipients are at particular high risk for postoperative respiratory failure as a result of poorly controlled pain, inadequate graft expansion, decreased cough, and reliance on systemic opioid therapy. Thoracic epidural and paravertebral blocks have been employed with the goal of improving postoperative pain control, improving pulmonary mechanics, and limiting the need for narcotic administration. These approaches require a needle position in proximity to the neuraxis and may cause significant hypotension that is poorly tolerated in transplant patients. Additionally, the use of anticoagulation or underlying clotting disorder limits the use of these regional blocks because of the concern of hematoma and subsequent neurologic injury. Ultrasound-guided continuous erector spinae plane (ESP) block has been shown to be efficacious for pain control following thoracotomy but has had minimal investigations following lung transplantation. In this study, we describe the effective use of a continuous erector spinae plane block to provide analgesia in a postoperative lung transplant recipient receiving systemic anticoagulation. The use of an ESP block with a more superficial needle tract that is further removed from the neuraxis allowed for a greater safety profile while providing efficacious pain control, decreased reliance on systemic narcotics, and improved oxygen saturation. The ESP block was effective in this case and thus may be a valuable alternative following lung transplantation for patients who are not candidates for thoracic epidural or paravertebral approaches.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2021 ","pages":"6664712"},"PeriodicalIF":0.0,"publicationDate":"2021-02-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7936898/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25486901","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unilateral Hypoglossal Nerve Palsy in a Patient with a Difficult Airway Requiring Prolonged Intubation.","authors":"Kahlin Leuzinger,&nbsp;Lopa Misra","doi":"10.1155/2021/8842503","DOIUrl":"https://doi.org/10.1155/2021/8842503","url":null,"abstract":"<p><p>Isolated cranial nerve injury is a very rare complication of anesthesia. Specifically, hypoglossal nerve palsy affects mobility of the tongue and basic functions of swallowing and speech, and injury can be associated with placement and/or positioning of the endotracheal tube. Many etiologies are described that are unrelated to anesthesia such as tumors, stroke, trauma, or surgical dissection. Identification of hypoglossal neuropraxic-type injury from compression or stretching during anesthetic procedures can be difficult and tends to be a diagnosis of exclusion. Here, we present a case of a unilateral isolated hypoglossal nerve palsy following prolonged intubation in a surgery that involved large fluid shifts resulting in tongue swelling, in which establishment of the airway was initially difficult requiring two attempts. We suggest it is equally as possible that stretch injury occurred during airway instrumentation versus prolonged compression of the nerve between the endotracheal tube and the hyoid bone, possibly relating to a swollen tongue. We outline some treatments that have been used in previous reports and analyze their relation to improvements in symptoms. We conclude that instrumentation of the airway and prolonged intubation are both potential risk factors for hypoglossal nerve palsy, and identification of these risk factors can improve patient care by prompting patient discussions, guiding intraoperative management, and initiating earlier therapies.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2021 ","pages":"8842503"},"PeriodicalIF":0.0,"publicationDate":"2021-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7906798/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25453652","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}