A&A Case Reports 最新文献

{"title":"Ultrasound-Guided Serratus Plane Block and Fast-Track Tracheal Extubation in the Operating Room for Thoracic Trauma Patients: A Case Report.","authors":"Pierfrancesco Fusco,&nbsp;Paolo Scimia,&nbsp;Stefano Di Carlo,&nbsp;Ambra Testa,&nbsp;Antonio Luciani,&nbsp;Emiliano Petrucci,&nbsp;Franco Marinangeli","doi":"10.1213/XAA.0000000000000600","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000600","url":null,"abstract":"<p><p>Painful rib fractures may be a factor in trauma patients remaining intubated and being given postoperative mechanical ventilation after emergency surgery. Regional techniques could provide sufficient analgesia in these patients to enable weaning and extubation and thus prevent or minimize complications related to prolonged ventilatory support. We describe a trauma patient with multiple rib fractures requiring an emergency splenectomy for whom an ultrasound-guided serratus plane block provided good quality pain relief for his rib fractures and enabled fast-track extubation in the operating room.</p>","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 11","pages":"305-307"},"PeriodicalIF":0.5,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000600","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35375658","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}

{"title":"Successful Assessment of Vocal Cord Palsy Before Tracheal Extubation by Laryngeal Ultrasonography in a Patient After Esophageal Surgery: A Case Report.","authors":"Natsuhiro Yamamoto,&nbsp;Yoshikazu Yamaguchi,&nbsp;Takeshi Nomura,&nbsp;Osamu Yamaguchi,&nbsp;Takahisa Goto","doi":"10.1213/XAA.0000000000000601","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000601","url":null,"abstract":"<p><p>Laryngeal ultrasonography has mainly been performed after tracheal extubation. However, improvements in ultrasound technology now allow assessment of vocal cord function even under conditions of endotracheal intubation. We report herein the use of laryngeal ultrasonography in an endotracheally intubated patient after esophagectomy, which allowed us to make the presumptive diagnosis of bilateral recurrent nerve palsy before tracheal extubation. Our experience suggests that laryngeal ultrasonography may be useful in assessing vocal cord function even in endotracheally intubated patients, although the indications and efficacy remain to be determined.</p>","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 11","pages":"308-310"},"PeriodicalIF":0.5,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000601","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35168534","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}

{"title":"Iatrogenic Endotracheal Tube Obstruction by Tegaderm.","authors":"Lance S Patak","doi":"10.1213/XAA.0000000000000602","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000602","url":null,"abstract":"332 www.anesthesia-analgesia.org December 1, 2017 • Volume 9 • Number 11 To the Editor While iatrogenic airway obstruction by foreign body has been well documented,1–3 I am compelled to report a case of complete airway obstruction by Tegaderm, which necessitated immediate removal of the endotracheal tube (ETT). A healthy 7-year-old, 26-kg boy presented for a mastoidectomy and endoscopic sinus surgery for chronic sinusitis. After induction of anesthesia a 5.5 oral RAE ETT was secured to the patient’s chin using benzoin tincture and plastic tape, followed by a Tegaderm dressing. The bed was turned 180°, and the ETT connections were pressed together to ensure tightness before the patient was prepped and draped. Approximately 40 minutes later, the flow sensor alarmed “low flow” with a pressure control setting 12 cm H2O. There was no obvious change in tidal volume (180–200 mL). Fractional inspired oxygen was maintained at 0.45 with total air and oxygen flows at 3 L/min. The cause for the low flow alarm could not be determined. While anesthesia technicians were inspecting the anesthesia ventilator, as well as air and oxygen intake connections, a massive leak in the system was noted with a loss of the end-tidal carbon dioxide waveform. Inspection of the anesthesia circuit revealed that the ETT had become disconnected from the circuit. Upon reconnection, there was immediate restoration of ventilation with the expected tidal volumes and a return of the end-tidal carbon dioxide waveform. But approximately 1 minute later, the end-tidal carbon dioxide waveform decreased in height by 50% and then quickly went flat, tidal volumes dropped to 0 mL, and peak inspiratory pressures increased to 30 cm H2O, all of which triggered multiple ventilator alarms. Given the lack of clarity as to the etiology of the previous low flow alarm, help was called immediately, oxygen flow was turned up to 10 L/min, and the surgical drapes were promptly removed in order to properly examine the patient and airway connections. With the patient’s oxygen saturation now at 46% and no chest or air movement, no apparent kinking in the ETT, and an inability to ventilate, the ETT was promptly removed without attempting to suction. Mask ventilation was performed followed by generous chest rise and a rapid return of oxygen saturation to 100%. On further examination of the ETT, it appeared that the Tegaderm had migrated internally and caused a complete obstruction in the distal end of the ETT (Figures 1 and 2). It is likely that the obstruction developed as the ETT was reconnected to the circuit. In the case of complete airway obstruction, the best first action is to attempt manual ventilation. If manual ventilation is not possible and bronchospasm is not suspected, dislodgment or obstruction of the ETT can be immediately diagnosed and treated by removal of the ETT and performing mask ventilation.4 The inability to suction the ETT may confirm that removing the ETT is the next best action, but th","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 11","pages":"332-333"},"PeriodicalIF":0.5,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000602","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35159531","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}

{"title":"Resistance to Propofol Induction in a Patient Taking Modafinil: A Case Report.","authors":"Timothy N Harwood","doi":"10.1213/XAA.0000000000000606","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000606","url":null,"abstract":"<p><p>After sedation with midazolam, induction of anesthesia with propofol was attempted in a patient taking modafinil. However, even after administration of a total of 6 mg/kg propofol IV, the patient continued to respond to tactile stimulation. Concurrently, the bispectral index was 72. Subsequent administration of low concentration sevoflurane by facemask induced an anesthetic depth that allowed unproblematic insertion of a laryngeal mask airway. Anesthesia for ophthalmologic surgery was maintained with sevoflurane. Modafinil may have caused resistance to propofol because of its effect on neural pathways that activate consciousness. The concentration of sevoflurane required to induce or maintain anesthesia remained unaltered.</p>","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 11","pages":"322-323"},"PeriodicalIF":0.5,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000606","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35375660","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}

{"title":"Anesthetic Management of an Infant With Postnatally Diagnosed Tracheal Agenesis Undergoing Tracheal Reconstruction: A Case Report.","authors":"Brittany L Willer,&nbsp;Kayla G Bryan,&nbsp;Daiva E Parakininkas,&nbsp;Michael R Uhing,&nbsp;Susan R Staudt,&nbsp;Kathleen M Dominguez,&nbsp;Michael E McCormick,&nbsp;Michael E Mitchell,&nbsp;John C Densmore,&nbsp;Keith T Oldham,&nbsp;Richard J Berens","doi":"10.1213/XAA.0000000000000603","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000603","url":null,"abstract":"<p><p>A term infant born cyanotic failed multiple intubation attempts and tracheostomy placement. After esophageal intubation resulted in the ability to ventilate, he was presumed to have tracheal agenesis and distal bronchoesophageal fistula. He was transferred to our institution where he was diagnosed with Floyd Type II tracheal agenesis. He underwent staged tracheal reconstruction. He was discharged to home at 4 months of age with a tracheostomy collar, cervical spit fistula, and gastrostomy tube. He represents the sole survivor-to-discharge of tracheal agenesis in the United States. We describe the anesthetic considerations for a patient with tracheal agenesis undergoing reconstruction.</p>","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 11","pages":"311-318"},"PeriodicalIF":0.5,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000603","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35180409","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}

{"title":"Intraoperative Acute Multivessel Coronary Vasospasm in Cardiac Allograft: A Case Report.","authors":"Richard Sheu,&nbsp;Kathleen Berfield,&nbsp;Stephanie Jones,&nbsp;Jay Pal,&nbsp;G Burkhard Mackensen","doi":"10.1213/XAA.0000000000000608","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000608","url":null,"abstract":"<p><p>We present a patient who developed acute intraoperative cardiac failure requiring open cardiac message immediately after uncomplicated heart transplantation. After successful resuscitation and establishment of extracorporeal membrane oxygenation, coronary angiography showed diffuse multivessel coronary vasospasm, which responded to intracoronary and IV administration of vasodilators. Cardiac function gradually improved and the patient was discharged home after a prolonged hospital course. Cardiac allograft dysfunction associated with coronary vasospasm immediately after heart transplantation has not previously been reported.</p>","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 11","pages":"328-331"},"PeriodicalIF":0.5,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000608","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35187648","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}

{"title":"When Faced With Anesthetizing an Infant With PHACE Syndrome: Watch Out for an Airway-Occluding Subglottic Hemangioma!","authors":"Monica S Shah,&nbsp;Susan T Verghese","doi":"10.1213/XAA.0000000000000604","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000604","url":null,"abstract":"","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 11","pages":"334-335"},"PeriodicalIF":0.5,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000604","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35375662","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}

{"title":"Oxymorphone Hydrochloride Extended-Release (OPANA®) Associated With Acute Kidney Injury in a Chronic Pain Patient: A Case Report.","authors":"Yan Yatsynovich,&nbsp;Dmitri Souza,&nbsp;Natallia Maroz","doi":"10.1213/XAA.0000000000000607","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000607","url":null,"abstract":"<p><p>Oxymorphone hydrochloride extended-release (OPANA®) is an opioid prescribed for the treatment of moderate-to-severe chronic pain. Kidney injury related to its use has not previously been reported. We present a case of a chronic pain patient with underlying chronic renal insufficiency who developed superimposed acute kidney injury when his opioid analgesic was changed from morphine sulfate extended-release to OPANA. Electron microscopy of his renal tissue revealed lamellated podocytes typically seen with drug-induced phospholipidosis.</p>","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 11","pages":"324-327"},"PeriodicalIF":0.5,"publicationDate":"2017-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000607","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35302067","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}

{"title":"Perioperative Management for Abdominal Surgery in Bilateral Diaphragmatic Paralysis: A Case Report and Literature Review.","authors":"Glenio B Mizubuti,&nbsp;Louie Wang,&nbsp;Anthony M-H Ho,&nbsp;Robert C Tanzola,&nbsp;Jordan Leitch","doi":"10.1213/XAA.0000000000000592","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000592","url":null,"abstract":"<p><p>The optimal approach to postoperative analgesia in patients with bilateral diaphragmatic paralysis undergoing abdominal surgery remains unclear. We report a 69-year-old woman with bilateral diaphragmatic paralysis who underwent a laparoscopic hernia repair and an open laparotomy for reversal of a Hartmann procedure under general anesthesia. Postoperative analgesia was provided by intravenous opioid and epidural local anesthetic and opioid, respectively. The patient's trachea was successfully extubated at the end of both surgical procedures. Epidural analgesia was associated with better pain control and shorter intensive care unit stay.</p>","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 10","pages":"280-282"},"PeriodicalIF":0.5,"publicationDate":"2017-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000592","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35157126","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}

{"title":"Genicular Radiofrequency Ablation for Treatment of Post Total Knee Arthroplasty Posterior Thigh Pain: A Case Report.","authors":"Lauren N Sylvester,&nbsp;Johnathan H Goree","doi":"10.1213/XAA.0000000000000596","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000596","url":null,"abstract":"<p><p>We present a case of a 68-year-old woman with 6 months of chronic unilateral posterior thigh pain after a total knee arthroplasty. The patient's pain was refractory to various treatments. After appropriate diagnostic tests, a genicular nerve block and subsequent radiofrequency ablation were performed. These procedures provided substantial pain relief of her thigh pain at 3 months follow-up.</p>","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 10","pages":"292-293"},"PeriodicalIF":0.5,"publicationDate":"2017-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000596","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35159529","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}