Case Reports in Anesthesiology最新文献

{"title":"Adequate Oxygenation State Maintained during Electroconvulsive Therapy in Nonobese Patients Using the Oxygen Reserve Index: A Pilot Study.","authors":"Yuji Kadoi, Jo Ohta, Yumeka Sasaki, Shigeru Saito","doi":"10.1155/2023/7807693","DOIUrl":"10.1155/2023/7807693","url":null,"abstract":"<p><p>Some controversial reports have observed oxygen desaturation (defined as percutaneous oxygen saturation (SpO₂) < 90%) during electroconvulsive therapy (ECT). The purpose of this pilot study was to examine oxygenation states in eight patients during ECT. In addition to the usual hemodynamic monitors and pulse oximeter, the oxygen reserve index (ORi) was monitored using a pulse oximeter. Patients received either no preoxygenation or preoxygenation with 100% oxygen via a tight-fitting mask for 1 or 3 min before induction of anesthesia. ORi increased after preoxygenation. ORi differed significantly between 3 min of preoxygenation and the other two methods before restarting mask ventilation. SpO₂ was significantly increased with all methods before stopping manual mask ventilation or before restarting manual mask ventilation compared with that before preoxygenation. No oxygen desaturation was observed at any time with any treatment methods. In nonobese patients, the adequate oxygenation state as shown by SpO₂ and ORi was maintained during ECT even without preoxygenation.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2023 ","pages":"7807693"},"PeriodicalIF":0.0,"publicationDate":"2023-11-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10643024/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"107592420","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":"Delayed Anaphylactic Reaction to Midazolam in the Absence of Immediate Respiratory or Skin Manifestations.","authors":"Andrew Winegarner,&nbsp;Mark C Kendall,&nbsp;Mekhala Stephen,&nbsp;Afreen Siddiqui","doi":"10.1155/2023/3873076","DOIUrl":"https://doi.org/10.1155/2023/3873076","url":null,"abstract":"<p><p>Anaphylaxis, a type 1 hypersensitivity reaction, is a feared but uncommon complication of medications administered in the perioperative period. The incidence of perioperative hypersensitivity reactions has been reported to range from 1 in 20,000 to 1 in 1,361. Anesthesiologists are well aware of common causes of hypersensitivity such as paralytics and antibiotics; however, less common triggers of anaphylaxis need to be considered as well. Midazolam, a short acting benzodiazepine metabolized by cytochrome P450 enzymes, is considered very safe with a minimal risk profile. Previous reports have described adverse reactions to occur within seconds to minutes following the administration of midazolam. We describe a patient with no known history of asthma or allergies who underwent elective hydrocelectomy with spinal analgesia without incident until 42 minutes later at the conclusion of the procedure, when they experienced circulatory collapse necessitating immediate emergency treatment. This case emphasizes the necessity to improve knowledge and awareness of delayed hypersensitivity reactions following the administration of perioperative medications such as midazolam.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2023 ","pages":"3873076"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10522439/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41172481","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":"Ultrasound-Assisted Management for Tracheal Intubation in the Patient with Tracheal Diverticulum.","authors":"Tingting Wan,&nbsp;Ya Gao,&nbsp;Changyi Wu","doi":"10.1155/2023/5586490","DOIUrl":"https://doi.org/10.1155/2023/5586490","url":null,"abstract":"<p><p>Tracheal diverticulum (TD) is a rare disease. Due to the worldwide pandemic of COVID-19, the increase of routine preoperative chest CT examination has led to a higher detection rate of TD. Although TD is very rare, it is one of the reasons for difficult intubation and difficult ventilation. Improper treatment can cause severe airway emergencies such as diverticulum tearing, tracheal rupture, and subcutaneous or mediastinal emphysema. Unfortunately, there are few studies on TD, especially in perioperative airway and anesthesia management. This paper reports a case of TD found by preoperative chest CT examination who required tracheal intubation under general anesthesia. For the first time, ultrasound was used to confirm the position of tracheal tube and TD, and good results were achieved. This attempt provides a new idea and method for airway management in patients with TD.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2023 ","pages":"5586490"},"PeriodicalIF":0.0,"publicationDate":"2023-09-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10522423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41172005","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":"Triple Threat: Significant Concomitant Aortic Stenosis, Mitral Stenosis, and Systolic Anterior Motion of the Mitral Valve Causing Left Ventricular Outflow Tract Obstruction in Cardiac Surgical Patients.","authors":"Katelyn Glines, J W Awori Hayanga, Christina Gibson, Mohamad El Churafa, Lawrence Wei, Heather K Hayanga","doi":"10.1155/2023/9995115","DOIUrl":"10.1155/2023/9995115","url":null,"abstract":"<p><p>Systolic anterior motion (SAM) describes a pathologic condition of the mitral valve in which the anterior leaflet is displaced anteriorly, resulting in a narrowed left ventricular outflow tract (LVOT). The implications of SAM may range in severity from clinically insignificant disease to severe LVOT obstruction resulting in hemodynamic collapse. While SAM is typically observed in patients with hypertrophic cardiomyopathy or following mitral valve repair, it may be seen in any setting in which the anatomy and function of the left ventricle has been altered. Here we discuss two patients who presented for aortic and mitral valve replacements for concomitant aortic and mitral stenosis. These cases were further complicated by the preoperative diagnosis of SAM in addition to the preexisting valvular lesions, further increasing the risk of sudden hemodynamic collapse and cardiac arrest.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2023 ","pages":"9995115"},"PeriodicalIF":0.0,"publicationDate":"2023-03-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10038731/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"9544545","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":"Rare Image of Epidural Catheter Fracture in Lumbar Analgesia.","authors":"Fiacro Jiménez-Ponce,&nbsp;Ylián Ramírez-Tapia,&nbsp;Erick Ariñez-Barahona,&nbsp;Jorge A Nava-López,&nbsp;Sai Naveen Alla","doi":"10.1155/2023/8880024","DOIUrl":"https://doi.org/10.1155/2023/8880024","url":null,"abstract":"<p><strong>Objective: </strong>Accidental fracture of epidural analgesia catheters has a very low incidence of 2.5 per 100,000 anesthesia. A rare image of the fracture is reported.</p><p><strong>Methods: </strong>A 42-year-old female patient was attending a cesarean section eight years earlier to her consult. In the cesarean section, she received regional epidural anesthesia, and the main complaint was low back pain, specifically between the spinous processes L2 and L3. The somatic pain had been presenting intermittently for eight years. The sagittal section of magnetic resonance imaging of the lumbar spine showed a \"golf club\" image from the midline to the laminae of L2 and L3 with the subcutaneous tissue.</p><p><strong>Results: </strong>A small right hemilaminectomy was performed to remove the complete catheter, which did not adhere, but was coiled in the S-shape. The catheter was trapped between the left facets of L2 and L3 laterally than through the midline. Several risk factors and therapeutic procedures have been proposed.</p><p><strong>Conclusion: </strong>In a systematic review, 24 articles were reported on this specific issue. No surgical procedure and follow-up were informed by 8 authors. Surgical remotion by laminectomy was used in 9 articles, surgical explanation by skin incision was reported by 4 authors, and remotion by endoscopy was reported in 1 article. Two articles not reported solution.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2023 ","pages":"8880024"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10477027/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10522942","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":"Video Laryngoscope Assistance in Button Battery Retrieval.","authors":"Sandy Ren,&nbsp;Heitor Lopes,&nbsp;Neil Masters","doi":"10.1155/2023/8550685","DOIUrl":"https://doi.org/10.1155/2023/8550685","url":null,"abstract":"<p><p>Foreign body ingestion remains a common cause of pediatric emergency surgery with button battery ingestion of particular concern. Newer, higher power lithium batteries can cause catastrophic damage of the gastrointestinal tract through erosion of mucosa into surrounding structures. Prompt diagnosis and treatment are paramount. We present a case of an 11-month-old with a button battery lodged in the proximal esophagus. The extraction was difficult and only made possible with the assistance of a video laryngoscope. We make the case for more routine usage of video laryngoscopy for removal of foreign bodies in the upper esophagus.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2023 ","pages":"8550685"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10499533/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10268108","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":"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":"Managing Anesthesia for a Patient with Takayasu Illness.","authors":"Gabriela Freitas,&nbsp;João Luiz Guerra,&nbsp;Cesar Henrique Fornero,&nbsp;Marina Delgado","doi":"10.1155/2023/2852203","DOIUrl":"https://doi.org/10.1155/2023/2852203","url":null,"abstract":"<p><p>This article intended to provide an overview of the anesthetic management for a patient with Takayasu arteritis, an uncommon and challenging disease. Despite the limited literature, it becomes more evident that there is no right answer for all patients. Considering that, it is important to take into account the severity and specific features of the underlying disease to decide the best anesthetic approach. In this context, an adequate preoperative assessment focusing on cardiovascular function becomes essential. Adequate cardiovascular monitoring is also essential in the intraoperative period. A multidisciplinary team should be involved in the perioperative period to provide the best care possible and improve patient outcomes. This case illustrates a successful hysterectomy in a patient with Takayasu arteritis, pointing out the pathophysiologic considerations and discussing the means to reduce the perioperative risk. The particularities described in this case report may help other physicians choose the best strategy when facing challenging patients similar to the one described.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2023 ","pages":"2852203"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9836809/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10527390","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}