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Case Reports in Anesthesiology
Number of Followers: 11

This is an Open Access Journal

Open Access journal
ISSN (Print) 2090-6382 - ISSN (Online) 2090-6390
Published by Hindawi

[340 journals]

In-Hospital Onset of Pseudothrombocytopenia Days before Surgery
- Abstract: Automated cell counters often produce spuriously low platelet counts due to laboratory artifacts. These in vitro phenomena may lead to erroneous treatments, surgical delays, and unnecessary platelet transfusions. An overlooked case of newly developed anticoagulant-induced platelet aggregation diagnosed in a preoperative visit is discussed and diagnostic clues are presented.
  PubDate: Mon, 31 Dec 2018 06:52:02 +000
Denture Induced Submandibular Hematoma in a Patient on Warfarin
- Abstract: A 79-year-old lady, who was taking warfarin, presented to the Emergency Department with a painless anterior neck swelling, which was associated with hoarseness of voice, odynophagia, and shortness of breath. She first noticed the swelling after she removed her dentures in the evening. On examination, she had an increased respiratory rate. There was a large submandibular swelling at the anterior side of her neck. Upon mouth opening, there was a hematoma at the base of her tongue, which extended to both sides of the tonsillar pillars. The patient was intubated with a video laryngoscope due to her worsening respiratory distress. Intravenous vitamin K and fresh frozen plasma were given immediately. The patient was admitted to the ICU for ventilation and observation. The hematoma subsided after 2 days and she was discharged well.
  PubDate: Mon, 17 Dec 2018 00:00:00 +000
Bradycardia Leading to Asystole Following Dexmedetomidine Infusion during
Cataract Surgery: Dexmedetomidine-Induced Asystole for Cataract Surgery
- Abstract: Dexmedetomidine is an elective alpha-2 adrenergic agonist, being used in anesthesia practice. It offers sedative, anxiolytic, analgesic, muscle relaxant, and sympathetic lytic properties. While respiratory effects are considered minor, there are important cardiovascular side effects with bradycardia and hypotension being the most common. This article presents a case of a patient, with significant comorbidities and polypharmacy, who was scheduled for cataract surgery under dexmedetomidine sedation. During the administration, severe hemodynamic deterioration was observed with bradycardia and hypotension leading to asystole. Cardiac arrest was successfully managed in accordance with the guidelines of the European Resuscitation Council. Despite the promising role of dexmedetomidine in anesthesia practice, the associated adverse effects cannot be ignored. For this reason it is obligatory to have the minimum mandatory monitoring in accordance with the safety and quality guidelines.
  PubDate: Wed, 05 Dec 2018 09:54:37 +000
Epidural Labor Analgesia for a Patient with Neuromyelitis Optica: A Case
Report and Review of the Literature
- Abstract: Neuromyelitis optica (NMO) is a rare demyelinating disorder affecting the spinal cord and optic nerves. Like multiple sclerosis (MS), it predominantly affects women during childbearing years. The impact of neuraxial anesthesia on the course of NMO is uncertain. There are no large studies available to draw definitive conclusions regarding the safety of neuraxial anesthesia in this population. A review of the current literature suggests that neuraxial anesthesia is unlikely to exacerbate neurologic symptoms in pregnant patients with NMO. However, given the rarity of this disease entity among patients requesting epidural labor analgesia, we recommend taking a cautious approach.
  PubDate: Tue, 04 Dec 2018 07:08:10 +000
Facilitating Airway Surgery in a Morbidly Obese Patient Using Transnasal
Humidified Rapid Insufflation Ventilatory Exchange (THRIVE)
- Abstract: Transnasal Humidified Rapid Insufflation Ventilatory Exchange (THRIVE) is a relatively new noninvasive oxygenation technique with a broad range of applications. It is used in the treatment of type one respiratory failure, as a preoxygenation tool, as a rescue and temporising measure in difficult airways, and as step-down oxygen therapy in patients after extubation. Its use has also been described in laryngeal surgeries, but they mainly involved normal-weight subjects or were used as a bridging oxygenation therapy before definitive airway is secured. The major benefits of using THRIVE in obese subjects undergoing laryngeal surgery include a tubeless and uninterrupted surgical field. This advantage is especially crucial in obese patients as they tend to have limited oropharyngeal space, rendering a shared airway technically challenging for surgeons. However, concerns of potential difficult airway and shorter safe apnoeic time in the obese population limit its use. In this case, we report its use as the sole oxygenation strategy in a morbidly obese patient undergoing airway surgery. Our experience suggests that THRIVE can provide a conducive operating field and adequate oxygenation in short apnoeic laryngeal procedures in the obese population, without causing excessive hypercarbia.
  PubDate: Mon, 19 Nov 2018 08:39:48 +000
Anaesthetic Considerations in a Patient with Pycnodysostosis undergoing
Caesarean Delivery
- Abstract: Pycnodysostosis is a rare congenital disorder with several implications, which might complicate anesthesia. Patients are more prone to fractures and have an anticipated difficult airway. We report a case of a 34-year-old woman with pycnodysostosis who underwent elective caesarean delivery under epidural blockade.
  PubDate: Tue, 13 Nov 2018 07:11:25 +000
A Case Report of Suspected Malignant Hyperthermia: How Will the Diagnosis
Affect a Patient’s Insurability'
- Abstract: The purpose of this case report is to increase awareness that a diagnosis of malignant hyperthermia may have long-lasting or permanent effects on a patient’s insurance eligibility or premiums despite legislation providing varying levels of protection from preexisting conditions or genetic discrimination. We present a case of severe rigors, unexplained severe metabolic acidosis, and severe hyperthermia in a patient after general anesthesia for extensive head and neck surgery. The patient was treated for malignant hyperthermia and demonstrated a significant clinical improvement with the administration of dantrolene. Even with an “almost certain” diagnosis of malignant hyperthermia by clinical presentation, genetic testing was negative and the gold-standard caffeine-halothane contracture test has yet to be performed. Laboratory results, clinical grading scales, and genetic testing support a diagnosis of malignant hyperthermia but the gold standard is a live muscle biopsy and caffeine-halothane contracture test. A clinical diagnosis of MH or a positive caffeine-halothane contracture test could result in exclusion from genetic discrimination legislature due to the fact that diagnosis can be confirmed without genetic testing. The fate of the Affordable Care Act may also affect how insurance companies scrutinize this disease. Improving accuracy of MH diagnosis in hospital discharge records will be crucial.
  PubDate: Tue, 30 Oct 2018 07:01:39 +000
Use of Awake Flexible Fiberoptic Bronchoscopic Nasal Intubation in Secure
Airway Management for Reconstructive Surgery in a Pediatric Patient with
Burn Contracture of the Neck
- Abstract: Although the use of awake flexible fiberoptic bronchoscopic (FFB) intubation is a well-recognized airway management technique in patients with difficult airway, its use in smaller children with burn contractures or in an uncooperative older child may be challenging. Herein, we report successful management of difficult airway in a 7-year-old boy with burn contracture of the neck, by application of FFB nasal intubation in a stepwise approach, first during an initial preoperative trial phase to increase patient cooperation and then during anesthesia induction for the reconstructive surgery planned for burn scars and contractures. Our findings emphasize the importance of a preplanned algorithm for airway control in secure airway management and feasibility of awake FFB intubation in a pediatric patient with burn contracture of the neck during anesthesia induction for reconstructive surgery. Application of FFB intubation based on a stepwise approach including a trial phase prior to operation day seemed to increase the chance of a successful intubation in our patient in terms of technical expertise and increased patient cooperation and tolerance by enabling familiarity with the procedure.
  PubDate: Sun, 21 Oct 2018 08:37:04 +000
Pharmacological Management of Severe Neuropathic Pain in a Case of
Eosinophilic Meningitis Related to Angiostrongylus cantonensis
- Abstract: Angiostrongylus cantonensis, the rat lungworm, is the most common infectious cause of eosinophilic meningitis and can be fatal. The parasite can be found throughout Southeast Asia and Pacific Islands and the global distribution is expanding. We present the case of a fourteen-year-old female who had previously traveled to Hawaii and developed severe neuropathic pain related to A. cantonensis infection refractory to gabapentin and pregabalin monotherapy, who was eventually managed with an ultralow dose ketamine infusion, methadone, and serotonin-norepinephrine reuptake inhibitor.
  PubDate: Wed, 17 Oct 2018 06:15:02 +000
Early Detection and Management of Massive Intraoperative Pulmonary
Embolism in a Patient Undergoing Repair of a Traumatic Acetabular Fracture
- Abstract: A 73-year-old male with history of hyperlipidemia and osteoarthritis was transferred from an outside hospital after a fall from a ladder at home. He sustained a severe right sided acetabular fracture involving the femoral head, requiring operative repair. Preoperative evaluation was unremarkable except for oxygen saturation < 95 %. After induction of anesthesia and surgical positioning, the patient went into cardiac arrest. After intraoperative cardiopulmonary resuscitation (CPR) and placement on extracorporeal membrane oxygenation (ECMO), the patient stabilized. Cardiac catheterization revealed a large left pulmonary embolism. Here, we discuss the etiology and management of intraoperative pulmonary embolism.
  PubDate: Mon, 01 Oct 2018 00:00:00 +000
Intrathecal Pump Implantation in the Cisterna Magna for Treating
Intractable Cancer Pain
- Abstract: A 54-year-old male patient with postoperative axillary lymph node, intrapulmonary, intracranial, and cervical spine metastases of left liver cancer was suffering from severe, persistent, and pricking pain in the right dorsal shoulder and right arm since 3 months. The drug dose of the fentanyl transdermal patch was gradually increased after admission and an adjuvant analgesic was also included, but neither treatment alleviated the pain. It was gradually alleviated after intramedullary analgesic infusion through intrathecal pump implantation in cistern magna. Terminally ill patients often have the desire to spend their remaining time at home, which however becomes a challenge in the face of refractory pain. At present, no palliative chemoradiation or ablative or stimulant neurosurgical options are available to manage pain in cancer patients. Based on the findings of this report, we concluded that an intramedullary drug infusion system can have a significant analgesic effect in patients with cervical metastasis and refractory cancer pain.
  PubDate: Tue, 25 Sep 2018 10:02:42 +000
Preoperative Fasting Guidelines in Children: Should They Be Revised'
- Abstract: Children presenting with ingestion of foreign bodies need gastroscopy as a primary management modality. A controversy lies regarding guidelines for preoperative fasting among children with low risk of aspiration and intraoperative complications. This case report represents cases of children who ingested foreign bodies and underwent fasting at different times preoperatively. With mounting evidence questioning the benefits of long durations of fasting in decreasing the risk of aspiration and with studies showing that fasting for more than 2 hours after ingestion of clear fluid does not significantly alter gastric pH or volume, these incidental findings raise the question of whether it is safe to keep children NPO, for a shorter duration before the administration of anesthesia. In addition, this report shows that current guidelines are in need of revision.
  PubDate: Sun, 26 Aug 2018 10:07:08 +000
Erratum to “Quadratus Lumborum Block as Sole, Homeostatic-Preserving
Anesthetic for a Patient with Multiple System Atrophy Undergoing Open
Inguinal Hernia Repair: A Case Report”
- PubDate: Sun, 19 Aug 2018 00:00:00 +000
Case Report of a Massive Thigh Hematoma after Adductor Canal Block in a
Morbidly Obese Woman Anticoagulated with Apixaban
- Abstract: Hematoma formation after peripheral nerve block placement is a rare event. We report a case of a morbidly obese patient who was anticoagulated with apixaban and developed a massive thigh hematoma after an ultrasound-guided adductor canal block. Despite continuous visualization of the block needle, an unrecognized vascular injury occurred leading to a 14-cm hematoma in the anterolateral thigh. Morbid obesity warrants additional risk consideration when placing nerve blocks in an anticoagulated patient. In addition, early recognition and expert consultation are both important in the management of block-related hematomas.
  PubDate: Mon, 13 Aug 2018 00:00:00 +000
Case Report of Subanesthetic Intravenous Ketamine Infusion for the
Treatment of Neuropathic Pain and Depression with Suicidal Features in a
Pediatric Patient
- Abstract: Chronic neuropathic pain and depression are often comorbid. Ketamine has been used to treat refractory pain. There is emerging evidence for use in depression. We present a case of a pediatric patient who was successfully treated with subanesthetic intravenous ketamine infusion for chronic neuropathic pain and suicidality.
  PubDate: Thu, 26 Jul 2018 06:35:36 +000
Ropivacaine Plasma Concentrations after 192-Hour High Dose Epidural
Ropivacaine Infusion in a Pediatric Patient without Side Effects
- Abstract: This case report discusses continuous epidural administration of ropivacaine 0.56 mg kg−1 h −1 for 8 days in a 7-year-old trauma patient to prevent pain, after performing a lower right and upper left leg guillotine amputation. Venous sampling after 8 days revealed bound and unbound ropivacaine concentrations of 1.1 mg/l and 0.06 mg/l in plasma, respectively. Arterial sampling for bound and unbound ropivacaine was 1.2 mg/l and 0.05 mg/l in plasma, respectively. In this case report, long-term high dose epidural infiltration of ropivacaine did not result in severe side effects or complications. Further studies are needed to explore safety of these concentrations in larger populations of children.
  PubDate: Wed, 11 Jul 2018 09:13:13 +000
Can ACE-I Be a Silent Killer While Normal Renal Functions Falsely Secure
Us'
- Abstract: The current case report represents a warning against serious hyperkalaemia and acidosis induced by ACE-I during surgical stress while normal renal function could deceive the attending anaesthetist. Arterial gas analysis for follow-up of haemoglobin loss accidentally discovered hyperkalaemia and acidosis. Glucose-insulin and furosemide successfully corrected hyperkalaemia after 25 minutes and acidosis after 3 hours. These complications could be explained by a deficient steroid stress response to surgery secondary to suppression by ACE-I. Event analysis and database search found that ACE-I induced aldosterone deficiency aggravated by surgical stress response with an inadequate increase in aldosterone secretion due to angiotensin II deficiency as a sequel of ACE-I leading to defective secretion of H+ and K+. Furosemide is recommended to secrete H+ and K+ compensating for aldosterone deficiency in addition to other antihyperkalaemia measures. Anaesthetising an ACE-I treated patient requires considering ACE-I as a potential cause of hyperkalaemia and acidosis.
  PubDate: Mon, 09 Jul 2018 00:00:00 +000
Percutaneous Epidural Hydrogel Sealant for the Treatment of Spontaneous
Intracranial Hypotension: A Case Report of Chronic Thoracic Neuralgia and
Technical Lessons Learned
- Abstract: We report a case in which a 34-year-old female with refractory intracranial hypotension headaches due to a spontaneous dural tear was ultimately treated with CT-guided transforaminal epidural placement of a synthetic absorbable sealant (DuraSeal®). The procedure successfully resolved her headaches; however she subsequently developed thoracic neuralgia presumably due to mass effect of the sealant material on the lower thoracic spinal cord and nerve roots. This case report describes the potential for significant spinal cord and nerve root compression as well as the development of chronic neuralgia with the placement of epidural hydrogel and fibrin glue sealants. Careful consideration should be taken into the needle gauge, needle position, injectate volumes, and injection velocity when delivering the sealant to the epidural space. Use of an 18-gauge Tuohy needle with a slow but steady injection pressure, constant patient feedback, and a conservative injectate volume (less than 2 ml per level) may best optimize sealant delivery to minimize the risk of spinal cord compression and neurologic injury.
  PubDate: Tue, 03 Jul 2018 09:47:42 +000
Quadratus Lumborum Block as Sole, Homeostatic-Preserving Anesthetic for a
Patient with Multiple System Atrophy Undergoing Open Inguinal Hernia
Repair: A Case Report
- Abstract: Quadratus Lumborum (QL) block has been successfully used for different abdominal procedures in the past. Multiple system atrophy (MSA) is a progressive neurodegenerative disorder characterized mainly by autonomic instability, motor impairment, and cognitive dysfunction. We report a case of a patient with MSA with a history of multiple episodes of unplanned admissions following outpatient minor surgical procedures under general anesthesia scheduled to undergo open inguinal hernia repair. In our patient, QL block was successfully used for surgical anesthesia and it resulted in hemodynamic stability and an opioid-free perioperative course.
  PubDate: Thu, 28 Jun 2018 13:56:34 +000
Glucose Management during Insulinoma Resection Using Real-Time
Subcutaneous Continuous Glucose Monitoring
- Abstract: Insulinoma is a rare neuroendocrine tumor that causes hypoglycemia due to unregulated insulin secretion. Blood glucose management during insulinoma resection is therefore challenging. We present a case in which real-time subcutaneous continuous glucose monitoring (SCGM) in combination with intermittent blood glucose measurement was used for glycemic control during surgery for insulinoma resection. The SCGM system showed the trends and peak of interstitial glucose in response to glucose loading and the change of interstitial glucose before and after insulinoma resection. These data were helpful for adjusting the glucose infusion; therefore, we think that an SCGM system as a supportive device for glucose monitoring may be useful for glucose management during surgery.
  PubDate: Thu, 07 Jun 2018 09:21:26 +000
Hemodynamic Response to Massive Bleeding in a Patient with Congenital
Insensitivity to Pain with Anhidrosis
- Abstract: A patient with congenital insensitivity to pain with anhidrosis (CIPA) underwent revision of total hip arthroplasty under general anesthesia with only propofol. During surgery, neither elevation of stress hormones nor hemodynamic changes associated with pain occurred; however, when blood was rapidly lost, compensatory tachycardia was observed. Although patients with CIPA are complicated with autonomic disturbance due to dysfunction of postganglionic sympathetic fibers, this compensatory response indicated that the adrenal glands in patients with CIPA secrete catecholamine as part of a compensatory response during bleeding under general anesthesia.
  PubDate: Sun, 03 Jun 2018 06:39:38 +000
Management of a Parturient with Mast Cell Activation Syndrome: An
Anesthesiologist’s Experience
- Abstract: Mast cell activation syndrome (MCAS) is a disorder in which patients experience symptoms and signs attributable to inappropriate mast cell activation and mediator release. Multiorgan involvement in patients can result in significant morbidity and possible mortality. Limited literature exists regarding anesthetic management of patients with MCAS. We report a case of vaginal delivery with neuraxial labor analgesia in a parturient with this condition and highlight the importance of multidisciplinary planning for uneventful outcomes. Stress can trigger life-threatening symptoms, and counseling is important to allay patients’ fears. Optimum medical control, adequate premedication, avoidance of triggers, and preparedness to treat serious mediator effects are key. We review MCAS and discuss anesthetic considerations for patients with this mast cell disorder.
  PubDate: Tue, 22 May 2018 00:00:00 +000
Unexpected Exacerbation of Tracheal Stenosis in a Patient with Hunter
Syndrome Undergoing Cardiac Surgery
- Abstract: We report unexpected exacerbation of tracheal stenosis during general anesthesia in a 50-year-old patient with Hunter syndrome undergoing cardiac surgery for valvular disease. He had undergone cervical laminoplasty 3 months previously; at that time, his airway had been uneventfully managed. Preoperative flexible fiberoptic laryngoscopy showed a normal upper respiratory tract, but chest computed tomography showed tracheal stenosis that had flattened the lumen. The narrowest part above the tracheal bifurcation was 2 cm long and the anteroposterior diameter was ≤6 mm. Cardiac surgery was uneventfully performed. After weaning from cardiopulmonary bypass, the tidal volume suddenly decreased from 450 to 120 ml at sternal closure. The end-expiratory carbon dioxide pressure increased from 39 to 71 mmHg. Bronchoscopic examination showed that the part of tracheal bifurcation was almost occluded. A tidal volume of 400 ml was obtained after the transesophageal echocardiography probe was removed and the peak inspiratory pressure increased. Although extubation was performed on the second postoperative day, procaterol inhalation and noninvasive positive-pressure ventilation were needed for 3 days because of wheezing and dyspnea. In conclusion, the risk of lower respiratory tract obstruction should be considered during general anesthesia in patients with Hunter syndrome with collapsible tracheal stenosis undergoing cardiac surgery.
  PubDate: Thu, 10 May 2018 07:13:48 +000
Airway Management during Thyroidectomy for a Giant Goitre due to
McCune-Albright Syndrome
- Abstract: There have been no case reports to date describing the technical aspects of tracheal intubation in a patient with a goitre associated with McCune-Albright syndrome (MAS), even though goitre is frequently observed in this condition. I describe a case of resection of a giant goitre in a patient with MAS, with difficult airway management. Preoperative investigation showed that the trachea was shifted to the right by the goitre, with the narrowest part of the tracheal lumen 4 mm in diameter. There was dome-shaped protuberance of the posterior pharyngeal wall into the airway. The patient had an S-shaped total spine, a short neck, and a relatively large jaw, which interfered with airway visualisation during intubation. Anaesthesia was induced with light sedation and supplemental oxygen. Endotracheal intubation was successfully performed using a fiberoptic laryngoscope and a flexible, spiral-wound, obtuse-tipped tracheal tube.
  PubDate: Sun, 06 May 2018 00:00:00 +000
Coccydynia Treated with Dorsal Root Ganglion Stimulation
- Abstract: Coccydynia can be difficult to resolve with conventional treatment options. Dorsal root ganglion (DRG) stimulation has recently emerged as a treatment for chronic pain, but its application has not been described in the context of coccydynia. We used DRG stimulation treatment in a patient suffering from intractable coccyx pain. At long-term follow-up, the patient experienced a decrease in pain intensity and improvement in function, without any complications. DRG stimulation may be a treatment modality for coccydynia refractory to other approaches.
  PubDate: Sun, 29 Apr 2018 09:32:41 +000
Erector Spinae Plane Block for Elective Laparoscopic Cholecystectomy in
the Ambulatory Surgical Setting
- Abstract: Postoperative pain after laparoscopic cholecystectomy can be severe. Despite multimodal analgesia regimes, administration of high doses of opioids is often necessary. This can further lead to several adverse effects such as drowsiness and respiratory impairment as well as postoperative nausea and vomiting. This will hinder early mobilization and discharge of the patient from the day surgery setting and is suboptimal in an Early Recovery after Surgery setting. The ultrasound-guided Erector Spinae Plane (ESP) block is a novel truncal interfascial block technique providing analgesia of the thoracic or abdominal segmental innervation depending on the level of administration. Local anesthetic penetrates anteriorly presumably through the costotransverse foramina to the paravertebral space. We demonstrate the analgesic efficacy of the ESP block in a case series of three patients scheduled for ambulatory laparoscopic cholecystectomy.
  PubDate: Sun, 01 Apr 2018 00:00:00 +000
Anesthetic Implications for Cesarean Section in a Parturient with Complex
Congenital Cyanotic Heart Disease
- Abstract: The discordance between increased physiological demand during pregnancy and congenital cardiac pathology of a parturient is a perilous threat to the maternal-fetal well-being. Early involvement of a multidisciplinary team is essential in improving peripartum morbidity and mortality. Designing the most appropriate anesthetic care will require a concerted effort, with inputs from the obstetricians, obstetric and cardiac anesthesiologists, cardiologists, neonatologists, and cardiothoracic surgeons. We report the multidisciplinary peripartum care and anesthetic management for cesarean section (CS) of a 28-year-old primigravida who has partially corrected transposition of the great arteries, atrial and ventricular septal defect, dextrocardia, right ventricle hypoplasia, and tricuspid atresia.
  PubDate: Thu, 29 Mar 2018 00:00:00 +000
Diagnosis and Thrombolytic Management of Massive Intraoperative Pulmonary
Embolism Guided by Point of Care Transthoracic Echocardiography
- Abstract: Perioperative pulmonary embolism can go undetected until the sudden onset of cardiopulmonary collapse. Point of care echocardiography in such setting can narrow the differential diagnosis of precipitous instability and facilitate tailored, rather than empiric, therapy in the event of a massive pulmonary embolism. We describe the diagnosis and successful multidisciplinary management of intraoperative massive pulmonary embolism aided by both transthoracic and transesophageal echocardiography. Key aspects regarding the classification and treatment of pulmonary embolism are subsequently reviewed.
  PubDate: Sun, 04 Mar 2018 07:24:55 +000
Erector Spinae Plane Block for Different Laparoscopic Abdominal Surgeries:
Case Series
- Abstract: The ultrasound guided erector spinae plane (ESP) block is a recent block described for various surgeries for postoperative analgesia. ESP block has effect on both visceral and somatic pain; therefore, its use in laparoscopic cholecystectomy and other abdominal surgeries can be advantageous. We describe successful ESP block application in three different cases for postoperative pain. Two patient were operated on using endoscopic retrograde cholangiopancreatography and laparoscopic cholecystectomy and one patient was operated on using laparoscopic cholecystectomy together with the inguinal hernia operation.
  PubDate: Sun, 18 Feb 2018 00:00:00 +000
Anesthetic Considerations for an Adult Patient with Freeman-Sheldon
Syndrome Undergoing Open Heart Surgery
- Abstract: Freeman-Sheldon syndrome (FSS) or “whistling face” syndrome is a rare congenital disorder complicated by characteristic facial deformities and muscular contractures. We report on a 64-year-old male patient presenting for surgical replacement of his aortic valve and review the available literature on anesthetic considerations and perioperative management principles. FSS frequently poses a significant challenge to airway management and gaining vascular access. Moreover, these patients are reportedly at risk for developing malignant hyperthermia (MH) or neuroleptic malignant syndrome.
  PubDate: Tue, 13 Feb 2018 00:00:00 +000