Case Reports in Anesthesiology最新文献

{"title":"Peripheral Nerve Stimulation for the Treatment of Phantom Limb Pain: A Case Series.","authors":"Robert Pagan-Rosado,&nbsp;Brandon J Smith,&nbsp;Fantley C Smither,&nbsp;Matthew J Pingree,&nbsp;Ryan S D'Souza","doi":"10.1155/2023/1558183","DOIUrl":"https://doi.org/10.1155/2023/1558183","url":null,"abstract":"<p><p>This case series aims to highlight the efficacy of peripheral nerve stimulation (PNS) in the treatment of phantom limb pain, as well as provide an alternative method for the treatment of this pain syndrome. In this report, we describe three amputee patients with severe phantom limb pain who obtained substantial analgesia and improvement in physical functionality after implantation of a temporary PNS device. Future studies should assess predictors of successful response or poor response to PNS therapy, such as mental health, environmental stressors, coping skills, and procedural factors. These factors may facilitate an individualized approach for each patient to ensure appropriate candidacy for PNS and better prognosis. Considering that patients in our cohort did not achieve long-lasting benefit after removal of temporary PNS, future research should assess if patients with phantom limb pain would benefit from permanent PNS, rather than temporary PNS.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2023 ","pages":"1558183"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10010869/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9122000","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":"Anesthetic Management of Laparoscopic Adrenalectomy for a Patient with Concomitant Pheochromocytoma and Bilateral Carotid Artery Stenosis.","authors":"Kristina L Michaud,&nbsp;Robert H Thiele,&nbsp;Katherine T Forkin","doi":"10.1155/2023/2172464","DOIUrl":"https://doi.org/10.1155/2023/2172464","url":null,"abstract":"<p><p>Symptomatic carotid stenosis and pheochromocytoma both require timely surgical intervention. Following a transient ischemic attack (TIA), a 46-year-old man was diagnosed with bilateral carotid artery stenosis and scheduled for carotid endarterectomy. He was a poor candidate for minimally invasive options due to prior neck radiation. Simultaneously, he began experiencing difficulty with diabetes management and elevated blood pressures and was ultimately diagnosed with pheochromocytoma. This unique situation required coordination to determine the appropriate timing of the two interventions. This case highlights the importance of communication and coordination amongst medical specialists and consideration for anesthetic management of patients with concomitant pheochromocytoma and carotid stenosis.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2023 ","pages":"2172464"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9840545/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10545919","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":"Remimazolam Anesthesia for Thyroid Surgery.","authors":"Sae Nakagawa,&nbsp;Tomoharu Shakuo,&nbsp;Sakurako Matsudo,&nbsp;Hiroaki Soda,&nbsp;Kenji Shida","doi":"10.1155/2023/2352693","DOIUrl":"https://doi.org/10.1155/2023/2352693","url":null,"abstract":"<p><strong>Background: </strong>Critical upper airway obstruction, hematoma formation, and recurrent laryngeal nerve palsy have been reported as postoperative complications of thyroid surgery. Although remimazolam may reduce the risk of these complications, the efficacy of flumazenil with remimazolam has not been reported. We present the successful anesthesia management of thyroid surgery using remimazolam and flumazenil. <i>Case Presentation</i>. A 72-year-old woman was diagnosed with a goiter and scheduled for a partial thyroidectomy under general anesthesia. We used remimazolam for induction and maintenance using a neural integrity monitor, electromyogram, and endotracheal tube under the bispectral index monitor. At the end of the surgery, spontaneous respiration was confirmed after the intravenous administration of sugammadex, and the patient was extubated under mild sedation. In the operating room, we administered flumazenil intravenously to confirm recurrent laryngeal nerve palsy and active postoperative hemorrhage. The patient was confirmed to have no recurrent laryngeal nerve palsy under full wakefulness but developed active postoperative hemorrhage with normal blood pressure. The patient required reoperation and was reintubated under intravenous administration of propofol. The anesthesia was maintained using 5% of desflurane, and the patient was extubated without any postoperative problems. The anesthesia was then terminated. The patient had no recall of the procedure.</p><p><strong>Conclusion: </strong>Maintenance of general anesthesia using remimazolam allowed the use of a neurostimulator with minimal muscle-relaxant effects, and extubation under sedation reduced the risk of abrupt and unexpected changes in blood pressure, body movement, and coughing. Furthermore, after extubation, the patient was rendered fully awake using flumazenil to confirm the presence of recurrent laryngeal nerve palsy and active postoperative hemorrhage. In addition, the patient had no memory of the reoperation, suggesting that the anterograde amnesic effect of remimazolam had a favorable psychological outcome associated with the reoperation. We safely managed thyroid surgery using remimazolam and flumazenil.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2023 ","pages":"2352693"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10202604/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9888084","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":"Effect of Arginine Vasopressin on Intraoperative Hypotension Caused by Oral Administration of 5-Aminolevulinic Acid.","authors":"Gen Owada,&nbsp;Hideo Nishizawa,&nbsp;Yuki Matoyama,&nbsp;Eri Watanabe,&nbsp;Keigo Mitsuda,&nbsp;Naoki Kaneko,&nbsp;Yasuhiro Kimura,&nbsp;Taikan Nanao,&nbsp;Junichi Fujimoto","doi":"10.1155/2023/1745373","DOIUrl":"https://doi.org/10.1155/2023/1745373","url":null,"abstract":"<p><p>5-Aminolevulinic acid (5-ALA) is used for the photodynamic diagnosis of malignant tumors and has been effectively utilized to improve the complete resection rate and reduce the risk of tumor recurrence. However, intraoperative hypotension is a common adverse effect of oral 5-ALA, and it occasionally progresses to severe prolonged hypotension requiring high-dose catecholamine administration. We report a case of intraoperative hypotension due to oral 5-ALA in which arginine vasopressin (AVP) administration was effective for increasing the blood pressure. A 77-year-old man scheduled for a craniotomy for glioma was administered 5-ALA orally before surgery. After the induction of anesthesia, his blood pressure decreased substantially. Although we administered various vasopressor agents, hypotension was prolonged. However, after starting a continuous administration of AVP, the systolic blood pressure increased, and the hemodynamic parameters remained stable during the remainder of the operation. 5-ALA administration may lower blood pressure by inducing nitric oxide production, and AVP inhibits inducible nitric oxide synthase messenger RNA expression and interleukin-1<i>β</i>-stimulated nitric oxide production. In light of these mechanisms, AVP may be a reasonable treatment agent for hypotension induced by 5-ALA.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2023 ","pages":"1745373"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10182879/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9487755","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 a Superficial Abdominal Wall Vein in a Gravida Patient for Emergency Vascular Access.","authors":"Christine Ha,&nbsp;Rotem Naftalovich,&nbsp;Faraz Chaudhry,&nbsp;Jean Eloy,&nbsp;Erica Spano,&nbsp;George Tewfik","doi":"10.1155/2023/1514940","DOIUrl":"https://doi.org/10.1155/2023/1514940","url":null,"abstract":"<p><p>Obtaining vascular access through a superficial vein of the abdominal wall of a gravida patient is an option in an emergency Cesarean surgery when other means fail. Such superficial veins may be mistaken for striae gravidarum on physical exam. A small intravenous (IV) cannula is not ideal but could save valuable time and avoid delaying induction of general anesthesia. Once the airway is secured, a larger bore IV can then be inserted while surgical exposure is undergoing. Analysis of the risks and benefits of inducing general anesthesia with a small gauge IV for a gravida patient should take into consideration risk factors for massive peripartum hemorrhage such as placental disorders (accreta, increta, precreta, abruption, or previa), presence of uterine fibroids, preeclampsia, hemolysis, elevated liver enzymes, low platelet count (HELP syndrome), severe polyhydramnios, history of grand multiparty, and bleeding disorders such as Von Willibrands and hemophilia.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2023 ","pages":"1514940"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10247316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9607711","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":"Perioperative Management of a Patient with Hemophilia C and Allergy to Fresh Frozen Plasma.","authors":"Sara Kianian,&nbsp;Giacomo Scorsese,&nbsp;Eric Zabirowicz,&nbsp;Jeremy Poppers","doi":"10.1155/2023/8973346","DOIUrl":"https://doi.org/10.1155/2023/8973346","url":null,"abstract":"<p><p>Hemophilia C is a rare bleeding disorder characterized by a deficiency in clotting factor XI (fXI) and has no standard of care for preoperative optimization before cardiac surgery. Normalization of fXI levels in patients with hemophilia C can be achieved with fresh frozen plasma (FFP), which sometimes results in allergic reactions. We present a case of a patient with hemophilia C requiring coronary artery bypass grafting surgery who developed an allergic reaction to FFP. Our report underscores the balance between thrombosis and bleeding risks when devising a perioperative plan for patients with hemophilia C.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2023 ","pages":"8973346"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10076113/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9627503","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":"Anesthetic Management of a Pediatric Patient with Congenital Methemoglobinemia.","authors":"Sung-Wook Choi,&nbsp;Elizabeth Putnam","doi":"10.1155/2023/3474638","DOIUrl":"https://doi.org/10.1155/2023/3474638","url":null,"abstract":"<p><p>A 15-year-old girl with congenital methemoglobinemia and no prior anesthetic history presented for the extraction of multiple impacted molars. Pulse oximetry values were expected to complicate the accurate monitoring of her oxygenation status in the perioperative period. An arterial line was placed for hemodynamic monitoring, arterial blood gas (ABG) analysis, and obtaining the methemoglobin (MetHgb) level and additional blood gases if clinically indicated. A continuous CO-oximeter was also used. Her intraoperative course was uneventful and she was discharged home on the same day of the procedure. This report reviews this rare condition and describes the monitoring methods utilized to assess her oxygen and methemoglobin levels, as well as the anesthetic techniques and pharmacologic agents employed. With appropriate intraoperative monitoring and careful drug selection, pediatric patients with this unusual condition can safely undergo general anesthesia.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2023 ","pages":"3474638"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9833929/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10536374","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":"The Use of Oxygen/Air Blender during Transoral Laser Microsurgery with Supraglottic Manual Jet Ventilation: A Safe Approach.","authors":"Sara Abu-Ghanem,&nbsp;James Cochran","doi":"10.1155/2023/5516988","DOIUrl":"https://doi.org/10.1155/2023/5516988","url":null,"abstract":"<p><strong>Background: </strong>Surgical fires are known, preventable, and devastating complications of transoral microlaryngeal laser surgery. Several guidelines have recommended maintaining the fraction of inspired oxygen concentration (FiO₂) at or below 30% for open delivery cases. We hereby present our experience utilizing an air/oxygen gas mixing device (blender) attached to a supraglottic manual jet ventilator during transoral laser microlaryngeal surgery in three cases to control oxygen levels.</p><p><strong>Methods: </strong>Retrospective chart review of three cases and literature review.</p><p><strong>Results: </strong>Three patients underwent microlaryngeal laser surgery and balloon dilation for the management of subglottic stenosis. All three patients were successfully ventilated throughout the procedures, and no major complications occurred intraoperatively. Two of three patients demonstrated symptomatic and clinical improvement at the first follow-up.</p><p><strong>Conclusions: </strong>This report demonstrates the successful use of an oxygen/air blender to reduce FiO₂ to fire-safe levels of less than 30% during laser surgery of the airway using jet ventilation.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2023 ","pages":"5516988"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10495234/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10242979","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":"Cesarean Delivery of a Parturient with Lumboperitoneal Shunt under Spinal Anesthesia.","authors":"Hicham Ziani,&nbsp;Med Yassir Lahbabi,&nbsp;Nabil Elachhab,&nbsp;Nawfel Elcaidi,&nbsp;Aziz Slaoui,&nbsp;Hanaa Lazhar,&nbsp;Sophia Lahbabi,&nbsp;Aziz Baidada,&nbsp;Nezha Oudghiri,&nbsp;Rajae Tachinante","doi":"10.1155/2023/8892695","DOIUrl":"https://doi.org/10.1155/2023/8892695","url":null,"abstract":"<p><p>Lumboperitoneal shunt may be indicated as a treatment for idiopathic intracranial hypertension aiming to facilitate the dynamic flow of cerebrospinal fluid into the peritoneum for patients. Parturients with lumboperitoneal shunt are a few, making it difficult to choose the analgesic or anesthetic technique for delivery. We present the case of a successful spinal anesthesia for a cesarean delivery in a parturient who was diagnosed with idiopathic intracranial hypertension that was treated by lumboperitoneal shunt.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2023 ","pages":"8892695"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10386897/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10286339","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":"Anesthesia Management of a Liver Transplant Recipient with Remimazolam.","authors":"Takashi Kawasaki,&nbsp;Takafumi Oyoshi,&nbsp;Naoyuki Hirata","doi":"10.1155/2023/5935657","DOIUrl":"https://doi.org/10.1155/2023/5935657","url":null,"abstract":"<p><strong>Background: </strong>Intraoperative anesthetic requirements might be altered due to the modulated metabolic function in living donor liver transplant recipients. Remimazolam may provide appropriate anesthesia in patients with cirrhosis. However, the efficacy and safety of remimazolam in liver transplant recipients have not been reported. We present the successful anesthesia management of a liver transplant recipient using remimazolam. <i>Case Presentation</i>. A 54-year-old woman who was diagnosed with Child-Pugh C cirrhosis of unknown etiology was scheduled for living donor liver transplantation. Remimazolam was used for anesthesia management under electroencephalogram monitoring, including bispectral index (BIS) and patient state index (PSI) values. Despite the prolonged surgical time (1,037 min) and massive blood loss (22,500 mL), BIS and PSI values were maintained within acceptable ranges intraoperatively. There was no intraoperative awareness/recall or adverse events associated with remimazolam administered perioperatively.</p><p><strong>Conclusions: </strong>We safely managed general anesthesia for living donor liver transplantation with remimazolam using electroencephalogram monitoring.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2023 ","pages":"5935657"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9851793/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10579539","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}