A&A practice最新文献

Morquio syndrome, a lysosomal storage disease, is associated with an increased risk of spinal cord ischemia with positioning changes.1 Though uncommon in non-spine surgeries, intraoperative neuromonitoring (IONM) can facilitate prompt detection of ischemia.2,3 We utilized IONM in an 11-year-old undergoing bilateral distal femoral osteotomies and lumbar epidural placement. After induction and supine baseline signal acquisition, the patient was positioned laterally. Signals were lost, and hypotension ensued. Phenylephrine and fluids were administered, but hypotension resolved only after supine repositioning. Without IONM, spinal cord ischemia may have caused permanent injury. This case emphasizes the importance of pre-positioning IONM in patients with Morquio Syndrome.

Rigid bronchoscopy is typically performed under general anesthesia, which can be unsafe in certain patients. The alternative is awake rigid bronchoscopy, which is rarely performed. This case concerns a patient with anaplastic thyroid cancer who presented with airway obstruction and respiratory distress. The patient had an obstructed trachea due to tumor invasion and compression. After performing ultrasound-guided superior laryngeal nerve blocks and airway topicalization to block the glossopharyngeal nerve, the obstruction was bypassed via an awake rigid bronchoscopy-guided tracheostomy. The awake rigid bronchoscopy procedure is feasible, and should be considered as an option in managing difficult airways.

Acute pancreatitis is a complex condition characterized by severe abdominal pain due to inflammation of the pancreas. In addition to pain, patients may present with symptoms such as nausea, vomiting, diarrhea, fever, and elevated pancreatic enzymes, including amylase and lipase. We report a case of recurrent acute pancreatitis precipitated by the administration of epidural steroid injections (ESIs), in the setting of a subsequent diagnosis of intraductal papillary mucinous neoplasm of the pancreas (IPMN).

Methylmalonic acidemia (MMA) is an autosomal recessive inborn error of branched-chain amino acid metabolism that leads to an accumulation of methylmalonic acid. This disorder is uncommonly encountered and can pose unique challenges during the peripartum period, specifically surrounding avoidance of catabolic states and metabolic decompensation. In this case report, we describe the preoperative optimization and peripartum considerations required for the successful anesthetic management of a patient with MMA undergoing a primary cesarean delivery.

Determination of organ transplant requires a layered approach, considering ethical principles, patient status, and projected outcomes. In this case, we present a difficult question of how to proceed if a patient anesthetized for heart transplantation experiences cardiac arrest in the operating room (OR) before establishment of cardiopulmonary bypass (CPB). The Organ Procurement and Transplant Network (OPTN), United Network of Organ Sharing (UNOS), and regulatory requirements fail to provide specific guidance. We explore various considerations involved in deciding whether to proceed, guided by ethical frameworks that recognize recipient and donor rights and broader societal aspects of transplantation.

The first Introduction to Clinical Research for Academic Anesthesiologists (ICRAA) Course took place from July 2024 through April 2025 via online interactive lectures. The 9-month course provided participants with the skills necessary to ethically design research proposals and conduct research projects. Some of the core principles taught included basics of biostatistics, ways to effectively communicate ideas to data analysts, how to write a grant, and tips on writing and analyzing scientific articles. In this report, we summarize the motivation, describe the content, and provide future directions for this initiative, which aims to foster high-quality clinical research among the next generation of academic anesthesiologists. .