Case Reports in Anesthesiology最新文献

{"title":"Suspected Sugammadex Hypersensitivity following Repeated Administration in the Setting of Multiple Flap Takebacks in a Brief Timespan.","authors":"Elizabeth G Zolper,&nbsp;Alan H Kim,&nbsp;Kevin G Kim,&nbsp;Paige K Dekker,&nbsp;Jenna C Bekeny,&nbsp;David H Song,&nbsp;Kenneth L Fan","doi":"10.1155/2021/5716159","DOIUrl":"https://doi.org/10.1155/2021/5716159","url":null,"abstract":"<p><p>Sugammadex hypersensitivity is an uncommon event that typically occurs at higher doses. We report a case of suspected sugammadex hypersensitivity in a patient who developed hypoxia and bronchospasm following three administrations of the standard 2 mg/kg doses of sugammadex within 26 hours due to flap takebacks. Hypersensitivity to sugammadex was not initially suspected given that the patient had previous exposures. Diagnoses of pneumothorax, hemothorax, mucus plug, and tracheal tube malposition were immediately ruled out. Furthermore, the onset of hypoxia with sudden loss of tidal volume, development of high peak airway pressures, and temporal correlation with sugammadex administration all supported bronchospasm secondary to a hypersensitivity reaction. Sugammadex is a useful agent for neuromuscular blockade reversal; however, it is critical to carefully examine all adverse reactions. This case report highlights the importance of considering hypersensitivity reactions in the setting of repeat sugammadex administrations in a limited timeframe, such as in free flap reconstruction requiring multiple takebacks to the operating room in the setting of flap compromise.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2021 ","pages":"5716159"},"PeriodicalIF":0.0,"publicationDate":"2021-08-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8405312/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39377103","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 Liposomal Bupivacaine in Pediatric Peripheral Nerve Blocks after Traumatic Amputation.","authors":"Gregory M Halenda,&nbsp;Stylianos Voulgarelis","doi":"10.1155/2021/8092204","DOIUrl":"https://doi.org/10.1155/2021/8092204","url":null,"abstract":"<p><p>Liposomal bupivacaine has been explored for indications in regional anesthesia, but little has been reported about its use in pediatric patients. In March 2021, the FDA approved an indication for liposomal bupivacaine as an infiltrated local anesthetic in children older than the age of six. Despite this recently expanded indication, the literature lacks reports of use for peripheral nerve blockade in children. We describe a case where liposomal bupivacaine was used for femoral and sciatic nerve blocks in a 5-year-old child with traumatic amputation of his lower leg. Pain control was excellent, with no pain or opioid use reported during the first 62 hours. After the regional anesthesia subsided, the patient required in total 4 oral doses of oxycodone 0.1 mg/kg prior to discharge. The patient did not develop chronic pain or phantom limb syndrome. While liposomal bupivacaine is not currently FDA-approved for peripheral nerve blockade in children, this case highlights a potentially effective use of this drug and possible area for further investigation.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2021 ","pages":"8092204"},"PeriodicalIF":0.0,"publicationDate":"2021-08-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8382517/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39344298","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":"Uncommon Occurrence of an Air Embolism during the Preanhepatic Phase of an Orthotopic Liver Transplant.","authors":"Klint J Smart,&nbsp;Saman Yaghoubian","doi":"10.1155/2021/6628961","DOIUrl":"https://doi.org/10.1155/2021/6628961","url":null,"abstract":"Vascular air embolism (VAE) during liver transplantation usually occurs during the dissection phase of the procedure or during liver reperfusion. If this phenomenon occurs, it can cause significant cardiovascular, pulmonary, and neurological complications. Prompt identification of VAE is essential, and the surgeon should be immediately notified. The mainstay treatment is identification and rectification of the source of the air embolus, hemodynamic support, and prevention of further air entrainment. This case report describes the occurrence of a pulmonary air embolism during the preanhepatic phase of an orthotopic liver transplant.","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2021 ","pages":"6628961"},"PeriodicalIF":0.0,"publicationDate":"2021-08-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8367452/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39324132","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":"Retracted: Intrathecal Pump Implantation in the Cisterna Magna for Treating Intractable Cancer Pain.","authors":"Case Reports In Anesthesiology","doi":"10.1155/2021/9814903","DOIUrl":"https://doi.org/10.1155/2021/9814903","url":null,"abstract":"<p><p>[This retracts the article DOI: 10.1155/2018/5287150.].</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2021 ","pages":"9814903"},"PeriodicalIF":0.0,"publicationDate":"2021-08-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8373483/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39334831","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 Patient with Harlequin Ichthyosis.","authors":"Klint J Smart,&nbsp;Catherine A Gruffi,&nbsp;Tara M Doherty","doi":"10.1155/2021/9953320","DOIUrl":"https://doi.org/10.1155/2021/9953320","url":null,"abstract":"<p><p>Harlequin ichthyosis is a severe and often fatal form of congenital ichthyosis caused by defective lipid transport which results in a dysfunctional skin barrier. Patients who survive the neonatal period are predisposed to skin infections, sepsis, impaired thermoregulation, and dehydration. The unique skin characteristics can present significant anesthetic challenges. We highlight the relevant anesthetic considerations in a 3-year-old presenting for syndactyly release of the right second and fourth digits. We describe the steps to ensure protection of the fragile skin barrier during establishment of intravenous access and airway management, therefore providing guidance for care of this vulnerable patient population.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2021 ","pages":"9953320"},"PeriodicalIF":0.0,"publicationDate":"2021-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8328734/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39277119","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":"Antisynthetase Syndrome with Severe Interstitial Lung Disease in Pregnancy.","authors":"Catalina I Dumitrascu,&nbsp;David A Olsen,&nbsp;Katherine W Arendt,&nbsp;Carl H Rose,&nbsp;Emily E Sharpe","doi":"10.1155/2021/1150394","DOIUrl":"https://doi.org/10.1155/2021/1150394","url":null,"abstract":"<p><p>Antisynthetase syndrome is a rare multisystem autoimmune disorder which clinically manifests with myositis, arthritis, interstitial lung disease, Raynaud phenomenon, and skin hyperkeratosis. Lung involvement represents the most severe form of disease and has rarely been reported in pregnancy. We present the case of a 22-year-old woman with antisynthetase syndrome and severe restrictive pulmonary disease who experienced a successful pregnancy and delivery. We discuss anesthetic considerations and highlight the importance of a multidisciplinary team approach in caring for parturients with multifactorial medical conditions.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2021 ","pages":"1150394"},"PeriodicalIF":0.0,"publicationDate":"2021-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8328709/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39276709","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":"Axonal Injury with Persistent Neuropathy following Popliteal Nerve Block for Cheilectomy Surgery.","authors":"Y A M Kuijpers,&nbsp;J M Setz,&nbsp;K Khemlani-Houthoff","doi":"10.1155/2021/9942195","DOIUrl":"https://doi.org/10.1155/2021/9942195","url":null,"abstract":"<p><p>Peripheral nerve blocks are often used for foot and ankle surgery. The occurrence of persistent neurological symptoms thereafter is very rare. Preventive strategies pose no guarantee and uncovering true etiology is often complicated. We discuss a case in which a young, healthy patient developed nerve damage after an uneventful popliteal block and cheilectomy. Nerve conduction studies revealed axonal injury in the distribution area of the sciatic nerve. The neurological symptoms persisted for more than 12 months, emotionally affecting the patient greatly. Patients will primarily report to the orthopedic surgeon, for whom cooperation with anaesthesia and neurology is of importance. Anesthetic involvement probably improves patient satisfaction during complication management.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2021 ","pages":"9942195"},"PeriodicalIF":0.0,"publicationDate":"2021-07-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8275396/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39203010","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":"Tricuspid Valve Replacement in a Patient with a Leadless Cardiac Pacemaker: Current Guidelines and Recommendations for Perioperative Management.","authors":"River Hames,&nbsp;J W Awori Hayanga,&nbsp;Diane Schmidt-Krings,&nbsp;Timothy Goldhardt,&nbsp;John Bozek,&nbsp;Donald Siddoway,&nbsp;Stanley Schmidt,&nbsp;John Lobban,&nbsp;Heather K Hayanga","doi":"10.1155/2021/5559830","DOIUrl":"https://doi.org/10.1155/2021/5559830","url":null,"abstract":"<p><p>Leadless cardiac pacemakers were developed to reduce complications associated with conventional transvenous pacemakers. While this technology is still relatively new, devices are increasingly being implanted. The perioperative management of patients with these devices has been underreported; we thus seek to add to the limited body of knowledge of perioperative management of patients with leadless cardiac pacemakers. An elderly female patient with a Micra VR transcatheter pacing system leadless cardiac pacemaker placed for tachycardia-bradycardia syndrome with intermittent complete heart block was scheduled for elective tricuspid valve replacement for severe tricuspid regurgitation. Pacemaker interrogation was performed several hours prior to the scheduled surgery based on the electrophysiologist's availability; the device was kept in its programmed VVIR mode, and the base rate was increased from 60 to 80 beats per minute in anticipation of the upcoming surgery. Upon preoperative evaluation, the anesthesiologist asked that the electrophysiology team be placed on standby intraoperatively due to the concern that either oversensing in the setting of pacemaker dependence and/or undesirable tachycardia from rate-responsive pacing could occur. The surgeon used monopolar electrocautery for the duration of the cardiac surgery. Despite the patient having evidence of pacemaker dependence in the intensive care unit preoperatively, no electromagnetic interference leading to oversensing nor rate modulation was detected during intraoperative electrocardiographic and intraarterial invasive monitoring. Evidence-based guidelines regarding perioperative management specifically of leadless cardiac pacemakers do not exist. As these devices become more prevalent, further evaluation will be paramount to determine whether existing guidelines for perioperative management of conventional transvenous pacemakers apply.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2021 ","pages":"5559830"},"PeriodicalIF":0.0,"publicationDate":"2021-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8266474/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39219983","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 \"Rash\" Decision in Anesthetic Management: Benzyl Alcohol Allergy in the Perioperative Period.","authors":"Michael Tripp,&nbsp;Matthew Ribeiro,&nbsp;Susanna Kmiecik,&nbsp;Ramon Go","doi":"10.1155/2021/8859823","DOIUrl":"https://doi.org/10.1155/2021/8859823","url":null,"abstract":"<p><p>Here, we present the case of a 54-year-old female presenting for outpatient ankle hardware removal who experienced severe total body pruritus along with a maculopapular rash persisting four days after the procedure. Patch testing demonstrated a sensitivity to benzyl alcohol, a preservative in propofol and several other anesthetics. The patient returned for left ankle arthroscopy a year later, and during that procedure, the anesthetic team avoided medications containing benzyl alcohol. This resulted in no pruritus or rash. Hypersensitivity reactions, ranging from contact dermatitis to anaphylaxis, are critical events in the perioperative period. Induction of general anesthesia has been implicated as the inciting event for perioperative hypersensitivity reactions. Benzyl alcohol is among a few excipients found in common anesthetic agents known to cause hypersensitivity reactions in susceptible patients. While reports of adult death are rare, infantile death due to benzyl alcohol has been described.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2021 ","pages":"8859823"},"PeriodicalIF":0.0,"publicationDate":"2021-06-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8249123/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39180796","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 Methylene Blue during Liver Transplantation for Vasoplegia.","authors":"Paul Harding,&nbsp;Thomas Nicholas,&nbsp;Cale Kassel","doi":"10.1155/2021/6610754","DOIUrl":"https://doi.org/10.1155/2021/6610754","url":null,"abstract":"<p><p>The use of methylene blue for vasoplegia in cardiac cases with cardiopulmonary bypass, septic shock, and acute liver failure is well documented. Use of MB for liver transplantation has been largely limited to case reports. We describe three separate liver transplantation patients with significant hypotension following reperfusion. Administration of methylene blue to each patient resulted in a significant decrease in vasopressor medication and two patients weaned completely. We argue that the use of MB should be considered as a treatment option for refractory hypotension.</p>","PeriodicalId":36504,"journal":{"name":"Case Reports in Anesthesiology","volume":"2021 ","pages":"6610754"},"PeriodicalIF":0.0,"publicationDate":"2021-06-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8245233/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39180795","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}