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Management of a Patient Requiring Intrathecal Drain Insertion and Removal in the Setting of Concomitant Dual Antiplatelet Therapy With Clopidogrel and Aspirin: A Case Report. 在氯吡格雷和阿司匹林双重抗血小板治疗中需要插入和移除鞘内引流管的患者的处理:1例报告。
A&A Case Reports Pub Date : 2017-06-01 DOI: 10.1213/XAA.0000000000000484
Christopher W. Connors, Janie D Nguyen
{"title":"Management of a Patient Requiring Intrathecal Drain Insertion and Removal in the Setting of Concomitant Dual Antiplatelet Therapy With Clopidogrel and Aspirin: A Case Report.","authors":"Christopher W. Connors, Janie D Nguyen","doi":"10.1213/XAA.0000000000000484","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000484","url":null,"abstract":"We report a case of deliberate intrathecal catheter insertion and removal in the setting of continuous dual-antiplatelet therapy with clopidogrel and aspirin. A patient with recently sited bare metal intracerebral stents developed severe symptomatic hydrocephalus and required temporary cerebrospinal fluid diversion. The risks of intracerebral in-stent thrombosis or delayed intervention precluded following guidelines for the management of clopidogrel in neuraxial procedures. Options to mitigate the risk of and facilitate the early detection of epidural hematoma are discussed when neuraxial instrumentation is indicated in the setting of clopidogrel and aspirin therapy.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"66 1","pages":"279-281"},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89169706","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Recognition of a Thoracic Epidural Hematoma in the Setting of Transient Paralysis: A Case Report. 短暂性麻痹时胸椎硬膜外血肿的识别:1例报告。
A&A Case Reports Pub Date : 2017-06-01 DOI: 10.1213/XAA.0000000000000492
B. VanderWielen, L. Rubenstein, M. Shnider, Cindy M. Ku, Jason S. Wakakuwa
{"title":"Recognition of a Thoracic Epidural Hematoma in the Setting of Transient Paralysis: A Case Report.","authors":"B. VanderWielen, L. Rubenstein, M. Shnider, Cindy M. Ku, Jason S. Wakakuwa","doi":"10.1213/XAA.0000000000000492","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000492","url":null,"abstract":"A 71-year-old woman on aspirin presented for a distal pancreatectomy, splenectomy, and partial colectomy with a T8/9 epidural catheter placed preoperatively in 3 attempts. Prophylactic 5000 units of subcutaneous heparin were given before the procedure. After catheter removal on postoperative day 2, the patient developed transient bilateral lower extremity paralysis, with near complete recovery within 30 minutes. An urgent MRI revealed a T4-T8 epidural hematoma prompting an emergent T3-T8 laminectomy. This case presentation highlights the need for heightened awareness regarding complications related to neuraxial analgesia in patients receiving unfractionated heparin for thromboembolism prophylaxis with concurrent aspirin use.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"61 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78739621","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
General Anesthesia and Fabry Disease: A Case Report. 全麻与法布里病1例报告。
A&A Case Reports Pub Date : 2017-05-15 DOI: 10.1213/XAA.0000000000000479
Stefan Krüger, A. Nowak, T. Müller
{"title":"General Anesthesia and Fabry Disease: A Case Report.","authors":"Stefan Krüger, A. Nowak, T. Müller","doi":"10.1213/XAA.0000000000000479","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000479","url":null,"abstract":"Fabry disease is an inherited X-linked disorder characterized by the absence (in men) or deficiency (in women) in α-galactosidase A activity that causes a progressive accumulation of glycosphingolipids within lysosomes of cells of all the major organ systems. The subsequent organ damage that manifests in childhood and early adulthood presents a widely variable clinical picture of pain, hypertension, and cardiac, renal, nervous system, and lung dysfunction. We present 2 female patients with Fabry disease who required general anesthesia twice for gynecological and trauma surgery, respectively, and discuss their perioperative management based on new information in the medical literature.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"14 1","pages":"247-249"},"PeriodicalIF":0.0,"publicationDate":"2017-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73103311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Two for One: A Case Report of Intravenous Lipid Emulsion to Treat Local Anesthetic Systemic Toxicity in Term Pregnancy. 二比一:静脉注射脂质乳治疗足月妊娠局麻全身毒性1例报告。
A&A Case Reports Pub Date : 2017-05-01 DOI: 10.1213/XAA.0000000000000477
Jonathan Dun-Chi Lin, Eellan Sivanesan, T. Horlocker, A. Missair
{"title":"Two for One: A Case Report of Intravenous Lipid Emulsion to Treat Local Anesthetic Systemic Toxicity in Term Pregnancy.","authors":"Jonathan Dun-Chi Lin, Eellan Sivanesan, T. Horlocker, A. Missair","doi":"10.1213/XAA.0000000000000477","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000477","url":null,"abstract":"Combined spinal-epidural (CSE) analgesia is a frequently used method of labor analgesia. Although it is considered safe and effective, CSE can be complicated by local anesthetic systemic toxicity (LAST), a potentially life-threatening condition. We present a case of LAST that developed in a primigravida 50 minutes after uneventful placement of a CSE. Her symptoms resolved within 10 minutes of administering intralipid emulsion. She subsequently underwent cesarean delivery under spinal anesthesia for failure to progress without sequelae in the mother or infant. LAST in pregnancy can occur at traditionally subthreshold dosing; anesthesiologists must be vigilant to ensure prompt and effective treatment.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81875373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 11
A Case Report: Subanesthetic Ketamine Infusion for Treatment of Cancer-Related Pain Produces Urinary Urge Incontinence. 一例报告:亚麻醉氯胺酮输注治疗癌症相关疼痛引起尿失禁。
A&A Case Reports Pub Date : 2017-05-01 DOI: 10.1213/XAA.0000000000000472
B. Vickers, Wayne S. Lee, Joann B. Hunsberger
{"title":"A Case Report: Subanesthetic Ketamine Infusion for Treatment of Cancer-Related Pain Produces Urinary Urge Incontinence.","authors":"B. Vickers, Wayne S. Lee, Joann B. Hunsberger","doi":"10.1213/XAA.0000000000000472","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000472","url":null,"abstract":"Oncology patients undergoing treatment can experience substantial pain related to their disease or prescribed therapy. Ketamine infusions at subanesthetic doses have been used at our institution to supplement the pain management regimens of 262 patients. We present 2 cases in which young adult patients being treated with subanesthetic ketamine for cancer-related pain experienced urinary urgency and incontinence after initiation or increase of the ketamine infusion. This adverse effect has not been reported previously at this dosing range. These case reports suggest that subanesthetic ketamine infusions may cause side effects that previously have been reported only at anesthetic or abuse doses.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"91 1","pages":"219-221"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76839466","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 7
Complete Antethoracic Block for Analgesia After Modified Radical Mastectomy: A Case Report 改良乳房根治术后完全胸前阻滞镇痛1例报告
A&A Case Reports Pub Date : 2017-05-01 DOI: 10.1213/XAA.0000000000000480
Hidemasa Takahashi, Takeo Suzuki
{"title":"Complete Antethoracic Block for Analgesia After Modified Radical Mastectomy: A Case Report","authors":"Hidemasa Takahashi, Takeo Suzuki","doi":"10.1213/XAA.0000000000000480","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000480","url":null,"abstract":"Complete antethoracic block for modified radical mastectomy is a composite block comprising the antethoracic medial, antethoracic inferior, and antethoracic lateral blocks. The puncture targets of all components are easy to identify, and the risk of complications such as pneumothorax is low. Our patient was a 72-year-old woman undergoing modified radical mastectomy for breast cancer. After induction of general anesthesia, but before surgical incision, she received a complete antethoracic block for anesthesia, which also provided good analgesia postoperatively. We believe that complete antethoracic block is suitable for postoperative analgesia in patients undergoing this surgery.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"8 6 1","pages":"250–253"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90813969","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
Case Report of Midazolam Withdrawal-Induced Catatonia in a 9-Year-Old Patient. 9岁咪达唑仑戒断致紧张症1例报告。
A&A Case Reports Pub Date : 2017-05-01 DOI: 10.1213/XAA.0000000000000482
Cassandra R. Duncan-Azadi, Peter N. Johnson, Andrew K Gormley
{"title":"Case Report of Midazolam Withdrawal-Induced Catatonia in a 9-Year-Old Patient.","authors":"Cassandra R. Duncan-Azadi, Peter N. Johnson, Andrew K Gormley","doi":"10.1213/XAA.0000000000000482","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000482","url":null,"abstract":"Benzodiazepine withdrawal-induced catatonia is a rare phenomenon in the adult population and has never been reported in a pediatric patient. We present a 9-year-old boy who exhibited catatonia symptoms following discontinuation of a midazolam infusion in the pediatric intensive care unit. The pediatric anesthesia acute pain team was consulted. When the patient's altered mental status could not otherwise be explained, benzodiazepine withdrawal-induced catatonia was considered. A dose of 2 mg intravenous lorazepam was given and the patient's symptoms dramatically improved within 5 minutes of administration. The patient was successfully treated with an oral diazepam taper.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"30 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74599981","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
Challenges in the Anesthetic Management for a Robotic Thymectomy in a Patient With Myasthenia Gravis: A Case Report. 重症肌无力患者机器人胸腺切除术麻醉管理的挑战:1例报告。
A&A Case Reports Pub Date : 2017-05-01 DOI: 10.1213/XAA.0000000000000471
Susan M. Martinelli, B. Lateef, J. Long, David Huang, A. Karmarkar, B. Barrick
{"title":"Challenges in the Anesthetic Management for a Robotic Thymectomy in a Patient With Myasthenia Gravis: A Case Report.","authors":"Susan M. Martinelli, B. Lateef, J. Long, David Huang, A. Karmarkar, B. Barrick","doi":"10.1213/XAA.0000000000000471","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000471","url":null,"abstract":"We describe the case of a patient with myasthenia gravis undergoing a robotic-assisted thymectomy complicated by postoperative myasthenic crisis, with a focus on the anesthetic considerations specific to this case. Because myasthenia gravis is an autoimmune disease affecting acetylcholine receptors, caution must be taken with the use of neuromuscular blockade and reversal. Utilizing a robotic-assisted surgical approach makes anesthetic management challenging given the dangers of patient movement while the robot is docked, lung isolation, extubation criteria, and postoperative disposition.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"91 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91417656","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Successful Management of a Patient With Possible Mast Cell Activation Syndrome Undergoing Pulmonary Embolectomy: A Case Report. 一例可能患有肥大细胞活化综合征的患者行肺栓塞切除术的成功治疗。
A&A Case Reports Pub Date : 2017-05-01 DOI: 10.1213/XAA.0000000000000476
Ellen W. Richter, K. Hsu, Vanessa Moll
{"title":"Successful Management of a Patient With Possible Mast Cell Activation Syndrome Undergoing Pulmonary Embolectomy: A Case Report.","authors":"Ellen W. Richter, K. Hsu, Vanessa Moll","doi":"10.1213/XAA.0000000000000476","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000476","url":null,"abstract":"We report the successful perioperative management of a patient with presumed mastocytosis undergoing pulmonary embolectomy. Postoperatively the patient went into vasodilatory shock, which was partly attributed to mast cell mediator release. H1- and H2-antagonists, steroids, and a single dose of methylene blue were given with improvement of hemodynamics. The patient was weaned off vasoactive substances and extubated by postoperative day 2. We discuss the perioperative management of patients with mastocytosis, briefly review the literature concerning anesthetic management for cardiac surgery in patients with this disorder, and discuss our patient's alternative but related diagnosis of idiopathic mast cell activation syndrome.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"12 1","pages":"232-234"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90215617","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Kounis Syndrome During Anesthesia: Presentation of Indolent Systemic Mastocytosis: A Case Report. 麻醉时的Kounis综合征:表现为无痛的全身肥大细胞增多症1例。
A&A Case Reports Pub Date : 2017-05-01 DOI: 10.1213/XAA.0000000000000474
E. de la Fuente Tornero, A. Vega Castro, Pedro Álvarez de Sierra Hernández, J. Balaguer Recena, Sofía Carmen Zaragoza Casares, Francisco Miguel Serrano Baylin, P. Gallardo Culebradas, Beatriz Amorós Alfonso, J. R. Rodríguez Fraile
{"title":"Kounis Syndrome During Anesthesia: Presentation of Indolent Systemic Mastocytosis: A Case Report.","authors":"E. de la Fuente Tornero, A. Vega Castro, Pedro Álvarez de Sierra Hernández, J. Balaguer Recena, Sofía Carmen Zaragoza Casares, Francisco Miguel Serrano Baylin, P. Gallardo Culebradas, Beatriz Amorós Alfonso, J. R. Rodríguez Fraile","doi":"10.1213/XAA.0000000000000474","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000474","url":null,"abstract":"Mastocytosis comprises a heterogeneous group of disorders characterized by mast cell accumulation and proliferation in distinct organs. Kounis syndrome is defined as the concurrence of acute coronary syndromes with mast cell activation in a setting of allergic or hypersensitivity reactions. This is the first reported case of an intraoperative Kounis syndrome as the onset of an indolent systemic mastocytosis probably triggered by succinylated gelatin infusion during general anesthesia. The presentation of this case is intended to contribute to the knowledge of mastocytosis and Kounis syndrome at the time of diagnostic workup during intraoperative anaphylaxis or myocardial ischemia.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79306512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 9
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