JournalTOCs

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

[343 journals]

Erroneous Activated Coagulation Time During Atrial Flutter Ablation
- Abstract: When performing left-sided catheter ablation, anticoagulation is used to prevent formation of thrombi that might embolize. After heparin administration, appropriate anticoagulation is confirmed by measuring Activated Coagulation Time (ACT). We report a case during which ACT results were erroneous, and review alternatives to the ACT under such circumstances.
  PubDate: Mon, 06 Jan 2020 12:35:00 +000
Intermittent Boluses of Local Anesthetic Through Quadratus Lumborum
Catheters for Analgesia in a Living Donor Hepatectomy
- Abstract: The demand for liver transplants in the United States far exceeds the supply of organs. As need has increased, so has use of living donors. Coagulopathy and various side effects often preclude the use of neuraxial regional techniques and opioids for postoperative analgesia in patients with large “J” incisions. Here, we present a 25-year-old male undergoing a living donor hepatectomy who received quadratus lumborum catheters placed percutaneously after closure of incision and prior to emergence to provide excellent analgesia and a viable opioid-sparing approach. Quadratus lumborum catheters are a safe option for a multimodal, opioid-sparing approach to analgesia.
  PubDate: Tue, 24 Dec 2019 07:35:01 +000
Anesthetic Management of a Voluminous Left Atrial Myxoma Resection in a 19
Weeks Pregnant with Atypical Clinical Presentation
- Abstract: We report the case of a semi-urgent cardiac surgery, in a 19 gestation age pregnant. Despite the fact that the patient was asymptomatic, except for some palpitations, a large left auricle (LA) myxoma was fortuitously diagnosed with transthoracic echocardiography (TEE). Considering the important embolic risk, the tumor was successfully removed during cardiac surgery under cardiopulmonary bypass (CPB). Fetal bradycardia following defibrillation under stable maternal and CPB conditions was successfully managed. The postoperative period and remainder of the pregnancy was smooth and the delivery uneventful.
  PubDate: Sun, 15 Dec 2019 11:50:01 +000
Sentinel Node Biopsy and Lumpectomy in a Patient with
Machado–Joseph Disease
- Abstract: Spinocerebellar ataxia 3 (SCA3), also known as Machado–Joseph disease (MJD) is an autosomal dominant, progressive neurodegenerative disorder. Patients present with cerebellar ataxia, dystonia, rigidity, and neuropathy that worsen with time. On a molecular level, it occurs due to a CAG trinucleotide repeat expansion in the ATXN3 gene. Due to the risk of pulmonary aspiration, hypoventilation, autonomic and thermoregulatory dysfunction, vocal cord paralysis, progressive paraplegia, parkinsonian symptoms, and chronic pain, it has significant anesthesia implications. Rarely, case reports occur in the literature describing regional anesthetic management of patients with SCA3, but none that describe general anesthesia specifically with MJD. We therefore describe a case of a patient with SCA3 who successfully underwent general anesthesia and considerations for perioperative management of this patient population.
  PubDate: Sun, 15 Dec 2019 07:50:01 +000
Intubation of a Patient with a Large Goiter: The Advantageous Role of
Videolaryngoscopy
- Abstract: Fiberoptic bronchoscopy has long been considered the gold standard for patients who present with a difficult airway. In the case presented, a patient has a large palpable goiter and requires intubation. After the unsuccessful attempt to intubate with the use of fiberoptic bronchoscopy, the decision to switch to videolaryngoscopy afforded a positive result. We present this case to suggest that the utilization of videolaryngoscopy may be an alternative option for intubation when other methods have failed. It is imperative for anesthesiologists to understand the benefits that this modality may provide.
  PubDate: Thu, 05 Dec 2019 10:05:00 +000
Intraoperative Kirschner Wire Migration during Robotic Minimally Invasive
Spine Surgery
- Abstract: We present the case of a 58-year-old woman who underwent a minimally invasive robotic-assisted L4-S1 instrumentation and fusion which was complicated by a Kirschner wire (K-wire) fracture and migration into the abdominal cavity necessitating emergent exploratory laparotomy. Retrieval of the K-wire proceeded without incident, and the patient had an otherwise uneventful surgery and recovery. This is the first such case description reported in the literature. As minimally invasive robotic-assisted spine procedures become more common, it is essential for the anesthesiologist to be familiar with potential complications to manage such patients in the perioperative period optimally.
  PubDate: Sun, 24 Nov 2019 09:05:00 +000
Corrigendum to “Change of Anesthesia Management for a Patient Undergoing
CABG by an Incidental Finding of a Genetic Variant Associated with
Malignant Hyperthermia”
- PubDate: Wed, 20 Nov 2019 13:05:00 +000
Aversion for Avulsion: A Case of Delayed Diagnosis of Traumatic Tricuspid
Rupture
- Abstract: Tricuspid rupture secondary to blunt force trauma is a rare diagnosis. However, the incidence of this injury is rising due to the improved initial treatment of complex trauma patients as well as enhanced early detection methods through the use of cardiac ultrasound. We report the case of an otherwise healthy 42 year old male who sustained significant blunt force trauma after a single motor vehicle accident. The diagnosis of traumatic papillary rupture and disruption of the valve apparatus was made on the day of admission after perioperative hemodynamic compromise and the use of intraoperative transesophageal echocardiography. However, treatment was delayed due to concerns of systemic anticoagulation leading to his eventual demise.
  PubDate: Tue, 05 Nov 2019 09:05:04 +000
Use of a Tracheal Tube as a Nasally Inserted Supraglottic Airway in a Case
of Near-Fatal Airway Obstruction Caused by Epiglottitis
- Abstract: Airway management is critical during near-fatal obstruction of the upper airway in epiglottitis; however, this is challenging because of the sitting posture and agitated mental status of the patient. Moreover, there is currently no established protocol for safe airway management in patients with epiglottitis. Here, we describe the use of a conventional tracheal tube as a nasolaryngeal airway to maintain airway patency at the site of airway narrowing in the supine position, which enabled alleviation of imminent airway obstruction in a patient with epiglottitis. For definitive airway establishment, tracheostomy was then safely performed in the supine position.
  PubDate: Thu, 31 Oct 2019 00:05:05 +000
Tongue Tied after Shoulder Surgery: A Case Series and Literature Review
- Abstract: This article presents three cases of cranial nerve palsy following shoulder surgery with general anesthesia in the beach chair position. All patients underwent preoperative ultrasound-guided interscalene nerve block. Two cases of postoperative hypoglossal and one case of combined hypoglossal and recurrent laryngeal nerve palsies (Tapia’s syndrome) were identified. Through this case series, we provide a literature review identifying postoperative cranial nerve palsies in addition to the discussion of possible etiologies. We suggest that intraoperative patient positioning and/or airway instrumentation is most likely causative. We conclude that the beach chair position is a risk factor for postoperative hypoglossal nerve palsy and Tapia’s syndrome.
  PubDate: Tue, 29 Oct 2019 09:05:04 +000
Corrigendum to “Bradycardia Leading to Asystole Following
Dexmedetomidine Infusion during Cataract Surgery: Dexmedetomidine-Induced
Asystole for Cataract Surgery”
- PubDate: Tue, 29 Oct 2019 08:05:05 +000
The Use of Succinylcholine in Brugada Syndrome: A Case Report and
Discussion of Literature
- Abstract: We describe a patient with a major depression and a newly discovered Brugada syndrome, who was successfully treated with 35 electroconvulsive therapy sessions using succinylcholine as muscle relaxant. We discuss the use of succinylcholine in patients with Brugada syndrome.
  PubDate: Sun, 27 Oct 2019 00:05:21 +000
Acute Awake Fiberoptic Intubation in the ICU in a Patient with Limited
Mouth Opening and Hypoxemic Acute Respiratory Failure
- Abstract: The incidence and survival of patients with head-and-neck cancer have been on the increase for decades. Following surgery or radiation therapy, complications such as difficult airways may evolve. These difficult airways may be unique and not manageable with conventional intubation methods as well as video laryngoscopes. Acute awake fiberoptic intubation may be a feasible option also for urgent emergency airway management of known difficult airways. The “cannot intubate–cannot oxygenate” (CI–CO) situation has to be avoided at all costs, since emergency cricothyrotomy has a fail ratio of more than 50% when performed by an anesthesiologist.
  PubDate: Wed, 23 Oct 2019 13:05:01 +000
Airway Compromise due to Retropharyngeal Emphysema–A Rare Complication
of an Extravasated Peripherally Inserted Central Venous Catheter
- Abstract: A 48-year-old woman was scheduled for flexible bronchoscopy, video-assisted thoracoscopic surgery and mediastinal washout. She had developed voice changes, difficulty swallowing, shortness of breath with a fever and increased respiratory rate in intensive care unit 12 days after a double liver and kidney transplantation. Computerised tomography of neck and chest demonstrated extensive retropharyngeal and subcutaneous emphysema, laryngeal distortion and pneumo-mediastinum; however, the causative factors were not immediately obvious. Intraoperatively, an un-anticipated diagnosis of extravasated peripherally inserted central venous cannula (PICC) was made. Total parenteral nutrition had extravasated into the mediastinum and thorax. Subsequent inflammation and infection resulted in air pocket formation. The retropharyngeal air pockets were caused by mediastinal emphysema tracking through the tissue planes to the anterior and posterior larynx. Awareness of the tip position and accompanying clinical and radiological enquiry, must be performed prior to use of PICC lines in critically ill patients.
  PubDate: Wed, 16 Oct 2019 15:05:00 +000
Massive Upper Body and Cervicofacial Subcutaneous Emphysema Following
Robotic Myomectomy
- Abstract: Subcutaneous emphysema is defined as the unintentional introduction of air or carbon dioxide in the subcutaneous tissues. The use of robotic surgical techniques has greatly expanded over the past decade specifically to treat intraperitoneal pathology. In general, advantages of these minimally invasive procedures are reported to decrease operating time, patient morbidity, and shorten hospital stay providing a safe alternative to traditional surgery. However, as with any surgery, potential complications may occur. We describe an unusual case of massive subcutaneous emphysema involving the upper body and cervicofacial region, with bilateral pneumothoraces following robotic intraperitoneal surgery. Written authorization was obtained from the patient.
  PubDate: Tue, 10 Sep 2019 10:05:00 +000
Pulmonary Artery Catheter Seemingly Entrapped in the Skull
- Abstract: A pulmonary artery catheter is an important tool for the monitoring of hemodynamics in patients. Unfortunately, misplacement of a catheter tip may occur in the vasculature local to the intended placement. Misplacement of the catheter can be further complicated by entrapment at the unintended destination. We present a case of a misplaced and entrapped pulmonary artery catheter in a patient with worsening pulmonary disease. After multiple unsuccessful attempts to float the catheter, it was partially retracted and found to be stuck. Imaging showed the tip terminating in the right internal jugular vein at the level of the jugular foramen. It was initially suspected that the catheter had become looped, knotted, or otherwise entangled within the vasculature of the skull and surgical removal would be necessary. Before surgical removal was performed, it was instead determined that the catheter had become kinked and entrapped at the end of the introducer sheath, and noninvasive removal was accomplished by first removing the introducer sheath.
  PubDate: Mon, 05 Aug 2019 10:05:12 +000
Persistent Left Superior Vena Cava (PLSVC) with a Connection to the Azygos
System: Case Report and Clinical Implications
- Abstract: Persistent left superior vena cava (PLSVC) is a rare anatomic variant that has a significant effect on the structure of the heart and venous system with clinical implications that are far-reaching. The presence of this variant is relevant to central venous catheter insertion, cardioverter-defibrillator placement, coronary artery bypass grafting, and numerous other medical procedures. In this report, we describe a rare case of PLSVC with a connection to the azygos system; notably, the vast majority of PLSVCs connect to the coronary sinus. We also discuss the anatomic and anesthetic considerations for individuals with this uncommon variant.
  PubDate: Mon, 05 Aug 2019 10:05:10 +000
A Patient with Graves’ Disease Scheduled for Thyroidectomy with High
Risk for Thyroid Storm Caused by Severe Medication Nonadherence:
Anaesthetic and Surgical Considerations
- Abstract: In patients with failed hormone regulation who are scheduled for indispensable total thyroidectomy, the risk of thyroid storm with severe end-organ complications has to be anticipated. This case report presents the successful surgical and anaesthesiological management of a patient with Graves’ disease, without any signs of perioperative thyroid storm. Possible recommendations for treatment are presented.
  PubDate: Mon, 22 Jul 2019 09:05:05 +000
Difficult Internal Jugular Central Venous Cannulation Using J-Tip
Guidewire with Indwelling Peripherally Inserted Central Venous Catheters
- Abstract: Central venous cannulation is a commonly performed procedure while managing critically ill patients; increasingly we encounter patients with indwelling wires or devices, like pacemakers, implantable cardioverter defibrillator devices, and peripherally inserted central venous catheters which complicate insertion of central venous catheters further. We present two cases where use of standard J-tip guidewire may have exacerbated the difficulty associated with internal jugular cannulation in presence of peripherally inserted central venous catheters. Recognition and avoidance of possible complications are crucial, and we discuss complexity posed by indwelling peripherally inserted central venous catheters and possible solutions.
  PubDate: Mon, 22 Jul 2019 07:05:07 +000
Explosive Vomiting Associated with Proximal Colonic Distention during a
Difficult Propofol-Assisted Colonoscopy
- Abstract: We present a case of explosive vomiting associated with the extensive manipulation of the proximal colon during a difficult colonoscopy procedure. The cause of vomiting in this case may have been multifactorial; however, proximal colonic distention was the most likely factor because the onset of vomiting coincided with proximal colonic manipulation and happened without any prodromal signs, coughing, and airway obstruction. Propofol, the sedative most commonly administered to the patient during colonoscopy, allows for a deep state of sedation, and consequently extensive colonic distention and scope manipulation. Colonic distention may lead to a higher risk of vomiting. We reviewed the neurocircuitry associated with vomiting and discussed why proximal colonic distention may increase the risk of vomiting. We emphasize vigilance during the manipulation of the proximal colon because vomiting increases the potential for aspiration pneumonitis and pneumonia in patients under deep propofol sedation with attenuated airway responses.
  PubDate: Wed, 17 Jul 2019 07:05:03 +000
Anesthetic Management of Total Aortic Arch Replacement in a Myasthenia
Gravis Patient under Deep Hypothermic Circulatory Arrest
- Abstract: The anesthetic management of myasthenia gravis patients undergoing cardiac or aortic surgery under cardiopulmonary bypass, especially with deep hypothermic circulatory arrest, is challenging. We describe a case of successful anesthetic management of a myasthenia gravis patient undergoing total arch replacement with deep hypothermic circulatory arrest under neuromuscular monitoring and complete reversal of the action of neuromuscular blocking drugs by sugammadex. The present case suggests that patients with well-controlled myasthenia gravis might be safely managed in cardiac or aortic surgery under cardiopulmonary bypass with deep hypothermic circulatory arrest.
  PubDate: Thu, 04 Jul 2019 13:05:06 +000
Ultrasound Guided Continuous Sciatic Nerve Block for Acute Herpetic
Neuralgia
- Abstract: Herpes Zoster (HZ) is the reactivation of a well-known viral disease which manifests itself with painful skin lesions. An effective analgesic method during the acute phase of HZ can contribute to decrease the incidence of postherpetic neuralgia (PHN) by reducing neural sensitization. Sciatic nerve block (SNB) is useful in the management of distal lower extremity pain sustained by the sciatic nerve. We describe our experience with a continuous ultrasound guided subgluteus sciatic nerve block in a patient with herpetic neuralgia- (HN-) related refractory acute left leg pain.
  PubDate: Tue, 02 Jul 2019 10:05:01 +000
A Case Report of Thalamic Infarction after Lumbar Drain: A Unique Cause of
Perioperative Stroke'
- Abstract: In the case presented, a patient has an unexplained episode of hypertension during aneurysm clipping. Following the procedure, the patient was discovered to have bilateral thalamic infarctions unrelated to the vascular location of the aneurysm. After a review of the case, it becomes apparent that intracranial hypotension caused by lumbar over drainage of cerebrospinal fluid (CSF) is the likely cause of both the episode of intraoperative hypertension and the thalamic infarcts. It is often presumed that having an open dura protects against intracranial hypotension and subsequent herniation. We present this case to suggest that opening the dura might not be protective in all cases and anesthesiologists must pay particular attention to the rate of CSF drainage. Lumbar CSF drainage is a technique frequently employed during neurological surgery and it is important for anesthesiologists to understand the signs, symptoms, and potential consequences of intracranial hypotension from rapid drainage.
  PubDate: Sun, 09 Jun 2019 13:30:02 +000
Anesthetic Management of a Patient with a Giant Pericardial Cyst
Compressing the Right Atrium
- Abstract: Pericardial cysts are rare mediastinal cysts composed of a single fluid-filled mesothelial layer and can be congenital in origin or develop secondary to pericarditis, trauma, or infection. Although most pericardial cysts are asymptomatic, life-threatening complications can occasionally occur. We report on a 57-year-old man with an asymptomatic 9 cm pericardial cyst that was incidentally found as an abnormal cardiac silhouette on routine chest radiography. Further imaging confirmed the presence of a pericardial cyst that was compressing the right atrium. The patient underwent successful video-assisted thoracoscopic removal of the pericardial cyst under general anesthesia. The patient’s postoperative course was uneventful and he was discharged on postoperative day 1 in a stable condition. To our knowledge, this is the first report regarding the anesthetic management of a patient with a giant pericardial cyst undergoing thoracic surgery. Knowledge regarding the perioperative challenges associated with the removal of pericardial cysts can prevent complications and improve patient outcomes.
  PubDate: Sun, 26 May 2019 12:05:00 +000
Intraoperative Pulmonary Embolism Diagnosed by Rescue Transesophageal
Echocardiography in a Morbidly Obese Patient Undergoing Orthopedic Surgery
following Motor Vehicle Crash
- Abstract: A case of intraoperative pulmonary embolism diagnosed by rescue transesophageal echocardiography in a morbidly obese patient undergoing orthopedic surgery following motor vehicle crash, who developed acute and persistent tachycardia, hypotension, and reduction of end-tidal CO2 during general and regional anesthesia, is described.
  PubDate: Sun, 26 May 2019 09:05:00 +000
Transient Asystole after Sugammadex Administration for Immediate Reversal
of Deep Blockade while on Dexmedetomidine Infusion in a Super Obese
Patient
- Abstract: Sugammadex is increasingly used to reverse aminosteroid neuromuscular blocking agents. Dosing is calculated based on actual body weight, even for those who are obese. We report a case where a super obese patient (BMI 58.5 kg/m2) developed asystole, following coadministration with dexmedetomidine, for rapid reversal after deep blockade. Although 16mg/kg of actual body weight is recommended for prompt reversal of deep blockade, dosing adjustments may be prudent in the obese population, especially when used in conjunction with other negative chronotropic agents.
  PubDate: Tue, 21 May 2019 11:05:03 +000
New Onset Tinnitus after High-Frequency Spinal Cord Stimulator
Implantation
- Abstract: The most common complications of spinal cord stimulation (SCS) therapy are generally related to surgical site infection and hardware malfunction. Less well understood are the adverse neurological effects of this therapy. We present the case of a patient who underwent placement of a Senza HF10 high-frequency spinal cord stimulator with subsequent development of tinnitus, vertigo, intermittent involuntary left facial twitches, and perioral numbness. These symptoms resolved following deactivation of her device. To further explore these less common neurologic complications of SCS therapy, a review of literature and a review of the U.S. Food and Drug Administration Manufacturer and User Facility Device Experience database are included. Further research and investigation in this area are needed so that clinicians and patients may have more complete knowledge and understanding of the potential treatment-limiting complications of spinal cord stimulation.
  PubDate: Thu, 02 May 2019 10:05:00 +000
Effective Analgesia with Bilateral Erector Spinae Plane Catheters for a
Patient with Traumatic Rib and Spine Fractures
- Abstract: Pain management in trauma patients with acute rib and spine fractures presents a challenge for the anesthesiologist and achieving adequate analgesia is important in preventing pulmonary complications. Unfortunately, neuraxial techniques are often challenging or contraindicated due to spine fractures or coagulopathy. Erector spinae plane (ESP) blocks provide an alternative regional anesthetic technique to manage pain. We describe a case of bilateral ESP catheters placed intraoperatively after spinal instrumentation in a patient with bilateral rib and spine fractures sustained in a tractor rollover crash. Prior to surgery, the patient had inadequate pain control and poor respiratory function despite multimodal analgesia. With the addition of bilateral ESP catheters, the patient’s pain control improved and he was weaned from respiratory support. ESP blocks have been shown to provide effective analgesia in patients with rib fractures; however, the utilization of these blocks has not been described in patients with spine fractures undergoing spinal instrumentation. Thus, ESP blocks provide a simple alternative to providing surgical and trauma analgesia when neuraxial techniques are contraindicated. The success of bilateral ESP catheters in our patient indicates a further area for application of ESP blocks in patients undergoing spine surgery with acute traumatic spine fractures.
  PubDate: Mon, 08 Apr 2019 07:05:06 +000
Preemptive ECMO Cannulation in a Patient with Severe Left Ventricular
Systolic Dysfunction Undergoing Cesarean Delivery
- Abstract: Obstetric patients with heart failure undergoing cesarean delivery are high risk and the perioperative care of these patients poses significant multidisciplinary challenges. In contrast to the nonobstetric patient population the potential role of mechanical circulatory support in parturients with heart failure is not well established and the use of extracorporeal membrane oxygenation (ECMO) has rarely been reported. We report the case of a super morbidly obese patient with decompensated heart failure, pulmonary hypertension, and superimposed preeclampsia undergoing preemptive ECMO cannulation for urgent cesarean delivery.
  PubDate: Mon, 08 Apr 2019 07:05:03 +000
Preeclampsia Induced Liver Dysfunction Complicated by Disseminated
Intravascular Coagulopathy and Placental Abruption: A Case Report and
Review of the Literature
- Abstract: A 33-year-old primigravida at 32-week gestation was admitted to labor and delivery complaining of severe right upper quadrant pain and worsening coagulopathy. We report the anesthetic and obstetrical management of a complex case of a parturient with a mixed picture of hemolysis, elevated liver enzymes and low platelets who was delivered under general anesthesia further complicated by Disseminated Intravascular Coagulopathy (DIC) and placental abruption.
  PubDate: Thu, 04 Apr 2019 13:05:04 +000