A&A Case Reports 最新文献

{"title":"Anesthetic Management of Two Pediatric Patients With Concurrent Diagnoses of Mitochondrial Disease and Malignant Hyperthermia Susceptibility: A Case Report.","authors":"Jonathon H Nelson,&nbsp;Richard F Kaplan","doi":"10.1213/XAA.0000000000000565","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000565","url":null,"abstract":"<p><p>We report the case of 2 pediatric patients with coexisting diagnoses of malignant hyperthermia susceptibility and mitochondrial disease in 2 different surgical settings. Due to the rare occurrence of each disorder, and even more so together, we reviewed evidence-based anesthetic concerns and described our perioperative management, with the goal of aiding future practitioners in safely caring for these patients. Consent was obtained for both patients, as well as IRB approval before publication.</p>","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 7","pages":"204-206"},"PeriodicalIF":0.5,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000565","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35079731","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":"Hitting the Nail on the Head: A Case Report Demonstrating the Importance of a Multidisciplinary Approach to an Unusual Penetrating Intracranial Injury.","authors":"Allison L Thoeny,&nbsp;Iman A Hadaya,&nbsp;Benn M Lancman,&nbsp;Vincent Lew","doi":"10.1213/XAA.0000000000000569","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000569","url":null,"abstract":"<p><p>A 28-year-old man presented with a penetrating injury by a nail gun to the head. Imaging revealed a nail abutting the superior sagittal sinus without active extravasation. An anesthesia-led multidisciplinary team devised a detailed perioperative plan including conception of a complex decision tree, coordination of care, and resource utilization. In the operating room, the nail was removed under general anesthesia, with blood products and equipment for craniotomy readily available, and imaging modalities reserved for immediate use. This case highlights the importance of a multidisciplinary approach to challenging penetrating head injuries and the crucial role anesthesiologists have as leaders in perioperative care.</p>","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 7","pages":"212-215"},"PeriodicalIF":0.5,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000569","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35026339","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":"Quantitative Neuromuscular Blockade Monitoring: Two Pictures of Unexpected Rocuronium Effect: A Case Report.","authors":"Paul A Leonard,&nbsp;Michael M Todd","doi":"10.1213/XAA.0000000000000568","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000568","url":null,"abstract":"<p><p>Wide variation in responses to neuromuscular blocking agents is well described but typically underappreciated in clinical practice. We present 2 patients with unexpected responses to rocuronium, despite being otherwise unremarkable. Quantitative neuromuscular monitoring provided clear documentation of the events, providing illustrations of these atypical responses.</p>","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 7","pages":"190-192"},"PeriodicalIF":0.5,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000568","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35026344","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":"Brachial Plexus Injury Associated With Subclavian Vein Cannulation: A Case Report.","authors":"Ezgi Gozubuyuk,&nbsp;Mehmet I Buget,&nbsp;Turgut Akgul,&nbsp;Demet Altun,&nbsp;Suleyman Kuçukay","doi":"10.1213/XAA.0000000000000566","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000566","url":null,"abstract":"<p><p>We documented brachial plexus injury by electromyography and magnetic resonance imaging secondary to needle sticks for central line insertion. This type of complication is rare in the literature, as few case reports exist. Brachial plexus injury can happen because of anatomic variations. Nevertheless, multiple attempts or introducer needle rotations should be avoided during subclavian vein catheterization. Pain that emerges in the ipsilateral arm after subclavian catheter placement should be taken into serious consideration. It is important to identify the cause of pain as soon as possible so that the correct treatment can be efficiently provided. Use of an ultrasound-guided catheterization may be a better choice for preventing complications.</p>","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 7","pages":"207-211"},"PeriodicalIF":0.5,"publicationDate":"2017-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000566","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35081682","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":"Persistent Hypotension and Cerebral Swelling Resulting From Mesenteric Traction Syndrome After Omental-to-Pial Pedicle Flap Transfer in a Young Woman With Refractory Moyamoya Disease: A Case Report.","authors":"Harvey J Woehlck,&nbsp;Suneeta Gollapudy,&nbsp;Christopher J Roberts,&nbsp;Akinwunmi Oni-Orisan,&nbsp;Raphael H Sacho,&nbsp;Paul S Pagel","doi":"10.1213/XAA.0000000000000557","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000557","url":null,"abstract":"<p><p>Superficial temporal arterial to middle cerebral arterial anastomosis is often the initial surgical treatment of Moyamoya disease. In refractory cases, placing a pedicle flap of omentum over the ischemic brain has resulted in clinical improvement or stabilization of symptoms. We present a case of persistent mesenteric traction syndrome manifested by hypotension unresponsive to conventional doses of vasopressors during and after pulling the omentum to the brain. As prostacyclin is a major mediator of hypotension from mesenteric traction syndrome and also a cerebral vasodilator, we discuss the possibility that brain swelling may be a manifestation of mesenteric traction syndrome.</p>","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 6","pages":"169-171"},"PeriodicalIF":0.5,"publicationDate":"2017-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000557","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35007130","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 Anesthetic Management for Cesarean Delivery in a Parturient With Type IV Loeys-Dietz Syndrome: A Case Report.","authors":"Ravish Kapoor,&nbsp;David G Mann,&nbsp;Emad B Mossad","doi":"10.1213/XAA.0000000000000561","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000561","url":null,"abstract":"<p><p>Loeys-Dietz syndrome (LDS) is a rare connective tissue disorder predisposing to aortic and arterial aneurysms. Presentations are classified into subtypes based on gene mutations. Pregnancy in patients with LDS is considered very high risk due to the potential for aortic dissection and uterine rupture. We report successful management of an elective cesarean delivery in a 16-year-old patient with LDS type IV using epidural anesthesia. Perioperative considerations and multidisciplinary management specific to taking care of parturients with LDS are discussed.</p>","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 6","pages":"182-185"},"PeriodicalIF":0.5,"publicationDate":"2017-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000561","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35081689","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":"A Kinked Epidural Needle Tip Preventing Placement of an Epidural Catheter.","authors":"Florin Costescu,&nbsp;Marcin Wąsowicz","doi":"10.1213/XAA.0000000000000567","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000567","url":null,"abstract":"186 www.anesthesia-analgesia.org September 15, 2017 • Volume 9 • Number 6 To the Editor Written informed consent for the publication of this letter was obtained from the patient. A 51-year-old nonobese man with no history of spine disease presented for exploratory laparotomy. The patient was seated for epidural catheter placement and his back was prepped and draped in a sterile fashion. The T9–T10 interspace was identified by surface bony landmarks and a first attempt was performed at midline using a 17-Ga Tuohy needle (Arrow Inc, Reading, MA). After 2 needle redirections, there was persistent bony contact and the approach was abandoned. No out-of-the-ordinary pressure was applied to the needle. A second attempt was performed at the same interspace with the same needle through a left paramedian approach. Loss of resistance was obtained at 6.5-cm depth from skin. Additionally, identification of the epidural space was confirmed via pulsatile waveform on epidural waveform analysis through the needle (for educational purposes).1,2 A 19-Ga catheter (FlexTip Plus, multiport, Arrow Inc) was advanced through the needle, but it was impossible to thread it past 11.5 cm, corresponding to the tip of the needle. At that point, multiple maneuvers were attempted to pass the catheter without success, including injection of saline through the needle, 1-mm advancement of the needle, and rotation of the needle. A third attempt was performed at the same interspace with the same needle through a right paramedian approach with the same result. Close examination of the epidural needle revealed a small kink at the tip, making passage of the catheter impossible (Figure). When a new needle was used with the same approach, the catheter was passed easily and good analgesia was obtained. Other mechanical complications involving epidural needles have been described previously. Schlake et al3 described a case of separation of the hub from the needle shaft. Two cases of fractured Tuohy needle have been reported in obese parturients.4,5 Finally, Lipov et al6 described severe kinking of a Tuohy needle during epidural steroid injection in an obese patient. In the present case, it is likely that forceful bony contacts caused denting of the tip of the needle, which was not noticed until careful visual examination was performed. Another possibility, although much less likely, is that there was a preexisting manufacturing defect. Difficulties with threading an epidural catheter through the needle are not uncommon and often result in maneuvers such as advancing the needle further or rotating it, thereby increasing the risk of dural puncture. It is also sometimes interpreted as inappropriate position of the needle tip outside of the epidural space. In our opinion, anesthesiologists should be aware of the potential for a kinked needle tip and be particularly suspicious when evidence of proper epidural space identification such as convincing loss of resistance or pulsatile epidural wavefo","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 6","pages":"186"},"PeriodicalIF":0.5,"publicationDate":"2017-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000567","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35003570","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":"Continuous Interscalene Block for Postoperative Analgesia and Shoulder Immobilization After Pectoralis Major Tendon Reinsertion: A Case Report.","authors":"John J Finneran,&nbsp;Brian M Ilfeld,&nbsp;Jacklynn F Sztain","doi":"10.1213/XAA.0000000000000559","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000559","url":null,"abstract":"<p><p>We present the case of a 38-year-old man undergoing surgical repair of his pectoralis major tendon. An interscalene catheter was placed between the middle and lower trunks of the brachial plexus. Postoperatively, ropivacaine 0.2% was infused through postoperative day 3. The patient had excellent pain control requiring minimal opioid analgesics. A catheter between the middle and lower trunks of the brachial plexus provided excellent postoperative analgesia after pectoralis major tendon reinsertion. Additionally, the block likely protected the surgical repair during emergence from anesthesia and in the early postoperative period by providing a motor block of the pectoralis major muscle.</p>","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 6","pages":"175-177"},"PeriodicalIF":0.5,"publicationDate":"2017-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000559","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35026342","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":"Use of a Tilting Orthopedic Fracture Table to Facilitate Proper Patient Positioning During Intrathecal Neurolysis With Hyperbaric Phenol: A Case Report.","authors":"Nathaniel H Loo,&nbsp;Gerald Matchett","doi":"10.1213/XAA.0000000000000556","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000556","url":null,"abstract":"<p><p>We describe the case of a 41-year-old woman with metastatic cervical cancer and a large mass eroding into the pelvis and left lumbosacral plexus. The patient had intractable left lower extremity pain refractory to standard therapies, and she elected to undergo intrathecal neurolysis. A diagnostic intrathecal block was performed at the T11-12 interspace followed by intrathecal neurolysis with 6% phenol in glycerin on a subsequent date. During both procedures, we used a tilting radiolucent orthopedic fracture table to maintain strict left lateral-supine positioning. A tilting orthopedic fracture table may be a valuable adjunct to ensure positional stability during intrathecal neurolysis.</p>","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 6","pages":"164-168"},"PeriodicalIF":0.5,"publicationDate":"2017-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000556","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35007128","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":"Case Report of a Massive Retropharyngeal Goiter Resulting in Laryngeal Compression.","authors":"Carissa M Thomas,&nbsp;Jameson K Mattingly,&nbsp;Adrian Hendrickse,&nbsp;John I Song","doi":"10.1213/XAA.0000000000000560","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000560","url":null,"abstract":"<p><p>This is a rare presentation of a morbidly obese male with a massive retropharyngeal goiter causing laryngeal compressive symptoms and unique airway management challenges. Flexible laryngoscopy revealed a retropharyngeal mass circumferentially compressing the oropharynx and supraglottis and preventing the visualization of the glottis. Awake tracheostomy was performed before total thyroidectomy. Airway compression from a goiter typically results from substernal extension, which usually does not cause difficulty with endotracheal intubation. Extensive retropharyngeal extension can cause supraglottic obstruction of the airway. In these cases, optimal management consists of a closely coordinated approach between anesthesia and surgery teams to establish a surgical airway.</p>","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 6","pages":"178-181"},"PeriodicalIF":0.5,"publicationDate":"2017-09-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1213/XAA.0000000000000560","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"35025920","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}