A&A Case Reports 最新文献

{"title":"Hemodynamically Directed Two-Person Chest Compressions: A Case Report.","authors":"Michael Dorbad,&nbsp;Ashley Kass,&nbsp;Michael Marvin","doi":"10.1213/XAA.0000000000000594","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000594","url":null,"abstract":"<p><p>Cardiopulmonary resuscitation has a low success rate both in and out of the hospital setting. Return of spontaneous circulation, however, is considerably higher for intraoperative cardiac arrests. Chest compressions remain of utmost importance. Optimal chest compression depth is believed to be greater than 5 cm. However, this depth is often not achieved. We describe a case in which the adequacy of chest compressions, based on hemodynamic monitoring, was achieved with 2 persons simultaneously providing a compressive force. This hemodynamic-directed care resulted in return of spontaneous circulation on 2 separate occasions.</p>","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 10","pages":"286-288"},"PeriodicalIF":0.5,"publicationDate":"2017-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000594","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35154987","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":"Sciatic (Popliteal Fossa) Catheter for Pediatric Pain Management of Sickle Cell Crisis: A Case Report.","authors":"Garret Weber,&nbsp;Sherry Liao,&nbsp;Micah Alexander Burns","doi":"10.1213/XAA.0000000000000598","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000598","url":null,"abstract":"<p><p>Sickle cell crisis, or vaso-occlusive crisis (VOC), is a major cause of hospitalizations for adults and children with sickle cell disease, and is associated with increased morbidity and mortality. Despite prompt pharmacological treatment and multimodal pain management, acute pain during a VOC is often not adequately controlled in the pediatric population. We placed a continuous popliteal sciatic nerve block under ultrasound guidance in a pediatric patient for localized refractory pain during a VOC, resulting in improved pain control with preserved sensorimotor function.</p>","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 10","pages":"297-299"},"PeriodicalIF":0.5,"publicationDate":"2017-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000598","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35159525","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":"Adenotonsillectomy for the Management of Pulmonary Hypertension in a Patient With Complex Congenital Heart Disease: A Case Report.","authors":"Adam C Adler,&nbsp;Yuan-Jiun Nicole Chao","doi":"10.1213/XAA.0000000000000593","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000593","url":null,"abstract":"Pulmonary hypertension is a feared complication in congenital heart disease patients. Patients with pulmonary hypertension are at risk for major perioperative cardiopulmonary complications when undergoing any surgical procedure, especially airway and laparoscopic procedures. We present the anesthetic management for a 2-year old with Down syndrome and complex cyanotic congenital heart disease undergoing tonsillectomy and adenoidectomy for severe obstructive sleep apnea.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 10","pages":"283-285"},"PeriodicalIF":0.5,"publicationDate":"2017-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000593","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35104408","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":"Stepwise Rostrocaudal Brainstem Anesthesia as a Complication of Local Anesthesia: A Case Report.","authors":"Braden Waters,&nbsp;Ryan R Kroll,&nbsp;John Muscedere,&nbsp;Lysa Boissé Lomax,&nbsp;Jessica E Burjorjee","doi":"10.1213/XAA.0000000000000591","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000591","url":null,"abstract":"<p><p>Iatrogenic cranial nerve palsies can rarely complicate neurosurgical, oral maxillofacial, and otolaryngological procedures. Among the most serious complications of cranial nerve palsy is upper airway obstruction, which is life threatening. We present a case of multiple cranial nerve palsies evolving rapidly in a rostrocaudal stepwise fashion after infiltration of lidocaine to repair a cerebrospinal fluid leak in a patient postoccipital craniectomy. This led to hypoxic respiratory failure requiring mechanical ventilation before resolving spontaneously. This is the first known case of accidental brainstem anesthesia secondary to lidocaine infiltration at an occipital craniectomy site and serves to caution clinicians who manage similar patients.</p>","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 10","pages":"277-279"},"PeriodicalIF":0.5,"publicationDate":"2017-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000591","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35154986","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":"Severe Postpartum Headache and Hypertension Caused by Reversible Cerebral Vasoconstriction Syndrome: A Case Report.","authors":"Ed McIlroy,&nbsp;Rajamani Sethuraman,&nbsp;Reshma Woograsingh,&nbsp;Catherine Nelson-Piercy,&nbsp;Edward Gilbert-Kawai","doi":"10.1213/XAA.0000000000000595","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000595","url":null,"abstract":"<p><p>Reversible cerebrovascular vasoconstriction syndrome is an uncommon condition that presents as severe headache and hypertension. Recent literature suggests a 1% incidence in postpartum headache cases. It can cause subarachnoid hemorrhages, cerebral ischemia, and seizures. It is often misdiagnosed as postdural puncture headache or preeclampsia. In this case, a postpartum woman, who had received epidural anesthesia for labor, presented 5 days postpartum with severe headache that did not resolve with an epidural blood patch. She then became more hypertensive and suffered a grand mal seizure. When treatment for eclampsia failed to resolve her symptoms, magnetic resonance angiography was performed. It demonstrated the pathognomic signs of reversible cerebrovascular vasoconstriction syndrome. Her symptoms resolved with nimodipine.</p>","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 10","pages":"289-291"},"PeriodicalIF":0.5,"publicationDate":"2017-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000595","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35159527","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":"Epidural Injections Contraindicated for Lumbar Radiculopathy in May-Thurner Syndrome: A Case Report.","authors":"Michael Sniderman","doi":"10.1213/XAA.0000000000000597","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000597","url":null,"abstract":"<p><p>A 59-year-old patient presented to the chronic pain clinic with a 6-week history of worsening lumbar back pain, bilateral thigh pain, and unilateral radiculopathy. Magnetic resonance imaging revealed mild discogenic and facetogenic disease, but significant epidural venous plexus engorgement compressing the thecal sac. The patient reported previous treatment by a vascular surgeon for May-Thurner Syndrome, a type of inferior vena caval obstruction, yet had not experienced these specific complaints. A discussion with the radiologist confirmed worsening of the patient's May-Thurner Syndrome was the likely cause of the patient's symptoms. The patient was referred back to the surgeon to relieve the venous obstruction because routine injection therapy would be ineffective.</p>","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 10","pages":"294-296"},"PeriodicalIF":0.5,"publicationDate":"2017-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000597","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35159528","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":"Ventricular Perforation During Open Surgical Balloon Expandable Mitral Valve Replacement: A Case Report.","authors":"Yousef M Hamdeh,&nbsp;Jordan E Goldhammer,&nbsp;Nicholas J Ruggiero,&nbsp;John W Entwistle","doi":"10.1213/XAA.0000000000000599","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000599","url":null,"abstract":"<p><p>A 79-year-old woman with severe mitral annular calcification was scheduled for mitral valve replacement. A SAPIEN 3 valve was implanted in mitral position using an open surgical approach. Immediately after cardiopulmonary bypass, bleeding from an unidentified source was encountered. Cardiopulmonary bypass was emergently resumed and a laceration of the left ventricular apex due to the valve delivery system was detected. Risk factors specific to the open surgical approach include a decompressed ventricle, decreased annulus to apical distance, and the absence of continuous fluoroscopic and echocardiographic imaging. These create a clinical scenario where risk of ventricular perforation is increased compared with traditional intravascular transcatheter valve delivery.</p>","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 10","pages":"300-304"},"PeriodicalIF":0.5,"publicationDate":"2017-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000599","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35159530","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":"The Role of Sugammadex in Symptomatic Transient Neonatal Myasthenia Gravis: A Case Report.","authors":"Jamie E Rubin,&nbsp;Radhamangalam J Ramamurthi","doi":"10.1213/XAA.0000000000000590","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000590","url":null,"abstract":"<p><p>We describe the case of a 3-week-old boy with pyloric stenosis who presented for laparoscopic pyloromyotomy in the setting of symptomatic transient neonatal myasthenia gravis. The patient received muscle relaxation with rocuronium, and neuromuscular blockade was successfully reversed with sugammadex with recovery guided by train-of-four monitoring. He was extubated uneventfully without complications. Because sugammadex binds directly to rocuronium rather than interfering with acetylcholine metabolism, it might provide a good option for reversal of neuromuscular blockade in transient neonatal myasthenia gravis.</p>","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 9","pages":"271-273"},"PeriodicalIF":0.5,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000590","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35154988","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":"In Response.","authors":"John A C Murdoch,&nbsp;Yuri Koumpan,&nbsp;Jason A Beyea,&nbsp;Michael Khan,&nbsp;Jaime Colbeck","doi":"10.1213/XAA.0000000000000583","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000583","url":null,"abstract":"November 1, 2017 • Volume 9 • Number 9 www.anesthesia-analgesia.org 275 In Response We thank Professor Grocott 1 for his interest and insightful comments regarding our case report. We agree that there is more than 1 way to secure a definitive airway in the case that we described, and in our report, we briefly discussed alternative techniques that we could have used including a wire through a fiberoptic bronchoscope (FOB) guided tube exchange.2 The previously described3,4 method, to which you refer, as used successfully by Hollingsworth et al5 uses an intraluminal FOB Aintree intubation catheter (AIC; Cook Medical Inc, Bloomington, IN) technique for exchanging the King Laryngeal Tube (LT; King Systems, Noblesville, IN) for an endotracheal tube (ETT). This does have the advantage, as you rightly pointed out, of reducing “step off” and hang up of the ETT when railroaded through the larynx in a Seldinger technique. Moreover, it also allows continued oxygen insufflation or limited lung ventilation via its hollow lumen (inner diameter 4.7 mm) and supplied Luer Lock or 15 mm connectors should endotracheal intubation not succeed. However, we would suggest that the intraluminal FOB AIC technique to which you refer would have been less than ideal in our situation and is why, although it is an accepted and welldescribed technique, we failed to reference it. In our discussion, we did elucidate several patient factors, peculiar to our case, that led us to choose a videolaryngoscope-guided extraluminal FOB approach to exchange the LT for an ETT. As the AIC has an outer diameter (OD) of 6.0 mm, the smallest ETT recommended by the manufacturer is 1 with an OD of 7.0 mm. Given that our patient had a large goiter displacing and compressing her trachea and had also had multiple attempts at direct laryngoscopy by prehospital paramedic staff, we were concerned that her laryngeal opening and tracheal airway might be significantly narrowed. This led us to use the extraluminal approach described, which allowed a narrower 6.5 mm ETT to be passed over the FOB. We also used an FOB with OD of 5.2 mm (Karl Storz, Tuttlingen, Germany); the recommended scope diameter for placing the AIC (inner diameter 4.8 mm) is 4 mm. The increased rigidity of a wider bronchoscope likely facilitated passage past the cuff of the LT, and the wider OD of the FOB reduced “step off” when railroading the ETT. Our technique did minimize interruption of minute ventilation allowing tight control of the Paco2, thus reducing further rises in intracranial pressure and avoiding respiratory acidosis given our patient’s expanding intracerebral hematoma and history of myotonic dystrophy. The FOB AIC technique also allows continued ventilation albeit through a reduced lumen due to the position of the FOB within the lumen of the LT. This might have made control of Paco2 more challenging. Regarding airway management, knowledge, preparation, and practice are critical, along with the need to avoid fixation error ","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 9","pages":"275"},"PeriodicalIF":0.5,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000583","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35180407","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":"Definitive Airway Management in the Presence of a Laryngeal Tube Supraglottic Airway: \"There's More Than One Way to Skin a Cat\".","authors":"Hilary P Grocott","doi":"10.1213/XAA.0000000000000584","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000584","url":null,"abstract":"xxx 2017 • Volume XXX • Number XXX www.anesthesia-analgesia.org 1 The recent case report by Koumpan et al 1 outlines the difficulties when one finds themselves “between the devil and the deep blue sea” when dealing with the need for establishing a definitive airway in a complex polytraumatized patient with closed head and C-spine injuries and a difficult airway. Indeed, they eloquently outline a successful technique to establish a definitive airway by exchanging the King Laryngeal Tube (LT) reusable supraglottic airway (King Systems, Noblesville, IN) for an endotracheal tube (ETT) with the use of a previously described flexible bronchoscopic (FB) guided intubation technique.2 Although it is hard to argue with success, there is clearly more than one way to address this problem. Even though these authors mention that a surgical airway can be considered3 (although perhaps not optimal in this particular patient), other techniques have been used for endotracheal intubation in the presence of an LT. Hollingsworth et al4 reported the use of an FB inserted through an Aintree intubation catheter (Cook Medical Inc, Bloomington, IN) in a similar situation of an in situ LT airway. Indeed, one of the problems of using the Seldinger-like technique that they describe in advancing an ETT over an FB is that the “step off” between the FB and the ETT (due to difference in diameter) can make ETT advancement difficult. The use of the Aintree catheter with an FB decreases this step off and allows the ETT to slide more smoothly through the larynx. So although they successfully report the use of their own FB and video laryngoscope technique, one needs to be cognizant of the multiple other airway adjuncts that are available “to skin the cat” represented by the in situ LT that needs replacing in the setting of a difficult airway.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 9","pages":"274"},"PeriodicalIF":0.5,"publicationDate":"2017-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000584","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35096341","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}