Pub Date : 2025-01-02eCollection Date: 2025-01-01DOI: 10.1213/XAA.0000000000001890
Basil Jouryyeh, Michael Beshara
Transcatheter aortic valve replacement (TAVR) is a common treatment for severe aortic stenosis (AS), but it carries the risk of severe complications, including device embolization. We present a case of a TAVR valve embolization into the left ventricular outflow tract (LVOT), diagnosed with transesophageal echocardiography (TEE) shortly after device deployment. The dislodged valve was successfully retrieved from the LVOT into the aorta, flattened, and stabilized with a thoracic endovascular aneurysm repair (TEVAR) stent, enabling the successful implantation of a new TAVR valve.
{"title":"Embolized Transcatheter Aortic Valve Replacement Diagnosed With Transesophageal Echocardiography and a Novel Management Strategy Using a Thoracic Endovascular Aneurysm Repair Stent.","authors":"Basil Jouryyeh, Michael Beshara","doi":"10.1213/XAA.0000000000001890","DOIUrl":"https://doi.org/10.1213/XAA.0000000000001890","url":null,"abstract":"<p><p>Transcatheter aortic valve replacement (TAVR) is a common treatment for severe aortic stenosis (AS), but it carries the risk of severe complications, including device embolization. We present a case of a TAVR valve embolization into the left ventricular outflow tract (LVOT), diagnosed with transesophageal echocardiography (TEE) shortly after device deployment. The dislodged valve was successfully retrieved from the LVOT into the aorta, flattened, and stabilized with a thoracic endovascular aneurysm repair (TEVAR) stent, enabling the successful implantation of a new TAVR valve.</p>","PeriodicalId":56372,"journal":{"name":"A&A practice","volume":"19 1","pages":"e01890"},"PeriodicalIF":0.5,"publicationDate":"2025-01-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142916069","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 Use of Trans-Esophageal Echocardiography in a Case of Truncus Arteriosus.","authors":"Mohit Prakash, Parag Gharde, Murtaza Sheikh Mohd, Jijo Francis, Rohan S Thottan","doi":"10.1213/XAA.0000000000001883","DOIUrl":"https://doi.org/10.1213/XAA.0000000000001883","url":null,"abstract":"","PeriodicalId":56372,"journal":{"name":"A&A practice","volume":"18 12","pages":"e01883"},"PeriodicalIF":0.5,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142856865","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}
Pub Date : 2024-12-12eCollection Date: 2024-12-01DOI: 10.1213/XAA.0000000000001886
Bahadir Ciftci, Serkan Tulgar, Bayram Ufuk Sakul, Selcuk Alver, Haci Ahmet Alici
Quadro-iliac plane block (QIPB) is a novel regional anesthesia technique that provides analgesia in the abdominal, lumbar, and hip regions. Case reports about the efficacy of this block in the literature are limited. In this report, we would like to share our successful QIPB experience with a patient with chronic myofascial low back pain.
{"title":"Inspiring Use of Novel Blocks in Chronic Pain Management: Quadro-iliac Plane Block a Promising Step Toward the Future-A Case Report.","authors":"Bahadir Ciftci, Serkan Tulgar, Bayram Ufuk Sakul, Selcuk Alver, Haci Ahmet Alici","doi":"10.1213/XAA.0000000000001886","DOIUrl":"10.1213/XAA.0000000000001886","url":null,"abstract":"<p><p>Quadro-iliac plane block (QIPB) is a novel regional anesthesia technique that provides analgesia in the abdominal, lumbar, and hip regions. Case reports about the efficacy of this block in the literature are limited. In this report, we would like to share our successful QIPB experience with a patient with chronic myofascial low back pain.</p>","PeriodicalId":56372,"journal":{"name":"A&A practice","volume":"18 12","pages":"e01886"},"PeriodicalIF":0.5,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815161","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}
Pub Date : 2024-12-12eCollection Date: 2024-12-01DOI: 10.1213/XAA.0000000000001854
Yuriy S Bronshteyn, Sundar Krishnan, Lior Abramson, Omar Al-Qudsi
{"title":"Scan That Barcode Carefully-Limitations of \"M-Mode\" Ultrasound When Screening for Pneumothorax.","authors":"Yuriy S Bronshteyn, Sundar Krishnan, Lior Abramson, Omar Al-Qudsi","doi":"10.1213/XAA.0000000000001854","DOIUrl":"https://doi.org/10.1213/XAA.0000000000001854","url":null,"abstract":"","PeriodicalId":56372,"journal":{"name":"A&A practice","volume":"18 12","pages":"e01854"},"PeriodicalIF":0.5,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142815163","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}
Pub Date : 2024-12-11eCollection Date: 2024-12-01DOI: 10.1213/XAA.0000000000001870
Rachel Barkley, Daniel J Vickers, Dhanesh D Binda, Rafael Ortega
{"title":"Una Analogía Auditiva Para la Comprensión del EEG: Video en Anestesia Clínica.","authors":"Rachel Barkley, Daniel J Vickers, Dhanesh D Binda, Rafael Ortega","doi":"10.1213/XAA.0000000000001870","DOIUrl":"10.1213/XAA.0000000000001870","url":null,"abstract":"","PeriodicalId":56372,"journal":{"name":"A&A practice","volume":"18 12","pages":"e01870"},"PeriodicalIF":0.5,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808308","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}
Pub Date : 2024-12-11eCollection Date: 2024-12-01DOI: 10.1213/XAA.0000000000001871
Rachel Barkley, Daniel J Vickers, Dhanesh D Binda, Rafael Ortega
{"title":"An Auditory Analogy for Electroencephalography Understanding: Video in Clinical Anesthesia.","authors":"Rachel Barkley, Daniel J Vickers, Dhanesh D Binda, Rafael Ortega","doi":"10.1213/XAA.0000000000001871","DOIUrl":"10.1213/XAA.0000000000001871","url":null,"abstract":"","PeriodicalId":56372,"journal":{"name":"A&A practice","volume":"18 12","pages":"e01871"},"PeriodicalIF":0.5,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142807747","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}
Pub Date : 2024-12-11eCollection Date: 2024-12-01DOI: 10.1213/XAA.0000000000001873
Pedro Tanaka, Marianne C Chen, Theodoro Beck, Mauren Carbonar, Yoon Soo Park, Alex Macario
<p><strong>Background: </strong>Holistic review of applications may optimize recruitment of residents by seeking out characteristics best aligned with program culture. The goals of this mixed methods research were to engage residency recruitment stakeholders to develop a holistic scoring rubric, measure the correlation between the rubric score and the final global rating used to rank applicants for the National Resident Matching Program Match, and qualitatively analyze committee discussions at the end of the interview day about applicants for potential unconscious biases.</p><p><strong>Methods: </strong>Forty stakeholders (32 faculty, 3 chief residents, and 5 administrative staff) completed an iterative consensus-driven process to identify the most highly valued applicant attributes, and a corresponding standardized question for each attribute. The rubric was used after the interview and after the group discussion to score all 203 applicants (29% underrepresented in medicine, 55% male) interviewed virtually during 1 recruitment season. Committee discussions of the day's candidates (15 separate interview days) were transcribed and analyzed using a phenomenological approach to identify biases.</p><p><strong>Results: </strong>The final rubric included 10 dimensions: interpersonal attributes, scholarship, leadership, resilience, medical knowledge, medical school performance (excluding test scores), community service, mature learner, motivation for anesthesiology, and diversity. The first 5 dimensions were given equal weight, while the next 4 had lower but equal weighting among them. Diversity received the lowest weight overall. The mean rubric score (max 36) equaled 25.92 (standard deviation [SD] 1.99, median 26, range 13-29), which was significantly correlated (r = 0.94, P < .001) with the final global rating (mean = 4.35 SD 0.29, range 2.25-4.9) used for ranking. The United States Medical Licensing Examination (USMLE) scores, underrepresented in medicine status, geographic region of the applicant, and gender were not correlated with the global rating. Interrater reliability among 32 committee members was high (r = 0.77, 95% confidence interval [CI], 0.73-0.80). Thematic analysis of 4079 coded text segments identified 9 major bias types, with the most common being: in-group bias for candidates perceived as being similar to typical residents currently in the program, stereotyping via opinions of the candidate's personality as being a good fit for the specialty, cohort bias comparing an applicant to other applicants that interview day instead of the entire season, and anchoring bias due to the interviewer's initial impression of the candidate's motivation to become an anesthesiologist.</p><p><strong>Conclusions: </strong>Stakeholder-driven holistic review that more broadly emphasizes an applicant's experiences and attributes can be successfully implemented in evaluating residency applicants. Committee discussions revealed various biases that warrant f
{"title":"Implementing Holistic Applicant Review and Addressing Biases in Anesthesiology Residency Committee Deliberations.","authors":"Pedro Tanaka, Marianne C Chen, Theodoro Beck, Mauren Carbonar, Yoon Soo Park, Alex Macario","doi":"10.1213/XAA.0000000000001873","DOIUrl":"10.1213/XAA.0000000000001873","url":null,"abstract":"<p><strong>Background: </strong>Holistic review of applications may optimize recruitment of residents by seeking out characteristics best aligned with program culture. The goals of this mixed methods research were to engage residency recruitment stakeholders to develop a holistic scoring rubric, measure the correlation between the rubric score and the final global rating used to rank applicants for the National Resident Matching Program Match, and qualitatively analyze committee discussions at the end of the interview day about applicants for potential unconscious biases.</p><p><strong>Methods: </strong>Forty stakeholders (32 faculty, 3 chief residents, and 5 administrative staff) completed an iterative consensus-driven process to identify the most highly valued applicant attributes, and a corresponding standardized question for each attribute. The rubric was used after the interview and after the group discussion to score all 203 applicants (29% underrepresented in medicine, 55% male) interviewed virtually during 1 recruitment season. Committee discussions of the day's candidates (15 separate interview days) were transcribed and analyzed using a phenomenological approach to identify biases.</p><p><strong>Results: </strong>The final rubric included 10 dimensions: interpersonal attributes, scholarship, leadership, resilience, medical knowledge, medical school performance (excluding test scores), community service, mature learner, motivation for anesthesiology, and diversity. The first 5 dimensions were given equal weight, while the next 4 had lower but equal weighting among them. Diversity received the lowest weight overall. The mean rubric score (max 36) equaled 25.92 (standard deviation [SD] 1.99, median 26, range 13-29), which was significantly correlated (r = 0.94, P < .001) with the final global rating (mean = 4.35 SD 0.29, range 2.25-4.9) used for ranking. The United States Medical Licensing Examination (USMLE) scores, underrepresented in medicine status, geographic region of the applicant, and gender were not correlated with the global rating. Interrater reliability among 32 committee members was high (r = 0.77, 95% confidence interval [CI], 0.73-0.80). Thematic analysis of 4079 coded text segments identified 9 major bias types, with the most common being: in-group bias for candidates perceived as being similar to typical residents currently in the program, stereotyping via opinions of the candidate's personality as being a good fit for the specialty, cohort bias comparing an applicant to other applicants that interview day instead of the entire season, and anchoring bias due to the interviewer's initial impression of the candidate's motivation to become an anesthesiologist.</p><p><strong>Conclusions: </strong>Stakeholder-driven holistic review that more broadly emphasizes an applicant's experiences and attributes can be successfully implemented in evaluating residency applicants. Committee discussions revealed various biases that warrant f","PeriodicalId":56372,"journal":{"name":"A&A practice","volume":"18 12","pages":"e01873"},"PeriodicalIF":0.5,"publicationDate":"2024-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142808190","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}
Pub Date : 2024-12-10eCollection Date: 2024-12-01DOI: 10.1213/XAA.0000000000001880
Tiffany G Liu, Liting Chen, Vicente Garcia-Tomas
Management of neuraxial catheters mandates consideration of comorbid conditions requiring anticoagulation, which may complicate their management. Cangrelor is an intravenous P2Y12 inhibitor with a plasma half-life of 3 to 6 minutes. Its use is indicated to reduce the risk of stent thrombosis. We present a case of a patient with an epidural catheter in situ who became critically ill, requiring antiplatelet therapy with cangrelor. We discuss pertinent considerations of neuraxial techniques in patients requiring cangrelor therapy and review existing guidelines for the management of these patients as well as current evidence of the use of platelet function tests in this setting.
{"title":"Competing Interests: A Case Report of Thoracic Epidural Management and Cangrelor Anticoagulation in a Critically Ill Patient.","authors":"Tiffany G Liu, Liting Chen, Vicente Garcia-Tomas","doi":"10.1213/XAA.0000000000001880","DOIUrl":"10.1213/XAA.0000000000001880","url":null,"abstract":"<p><p>Management of neuraxial catheters mandates consideration of comorbid conditions requiring anticoagulation, which may complicate their management. Cangrelor is an intravenous P2Y12 inhibitor with a plasma half-life of 3 to 6 minutes. Its use is indicated to reduce the risk of stent thrombosis. We present a case of a patient with an epidural catheter in situ who became critically ill, requiring antiplatelet therapy with cangrelor. We discuss pertinent considerations of neuraxial techniques in patients requiring cangrelor therapy and review existing guidelines for the management of these patients as well as current evidence of the use of platelet function tests in this setting.</p>","PeriodicalId":56372,"journal":{"name":"A&A practice","volume":"18 12","pages":"e01880"},"PeriodicalIF":0.5,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803588","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}
Pub Date : 2024-12-10eCollection Date: 2024-12-01DOI: 10.1213/XAA.0000000000001879
Anastasia Bui, Joanna Serafin, Suken Shah, Kara M Barnett
Patients with aortic stenosis (AS) and other significant cardiopulmonary comorbidities are vulnerable to hemodynamic instability during anesthesia. This case report compares the use of remimazolam and midazolam in a 71-year-old man with symptomatic AS, chronic kidney disease, and ischemic cardiomyopathy. The patient underwent multiple short ambulatory interventional radiology procedures. While moderate sedation with midazolam resulted in significant hypotension, use of remimazolam in subsequent procedures demonstrated a stable hemodynamic profile despite increased disease burden. This report highlights the potential advantages of remimazolam compared to midazolam in high-risk patients undergoing interventional radiology procedures.
{"title":"Hemodynamic Stability of Midazolam versus Remimazolam During Outpatient Genitourinary Interventional Radiology Procedures in a Patient With Aortic Stenosis: A Case Report.","authors":"Anastasia Bui, Joanna Serafin, Suken Shah, Kara M Barnett","doi":"10.1213/XAA.0000000000001879","DOIUrl":"10.1213/XAA.0000000000001879","url":null,"abstract":"<p><p>Patients with aortic stenosis (AS) and other significant cardiopulmonary comorbidities are vulnerable to hemodynamic instability during anesthesia. This case report compares the use of remimazolam and midazolam in a 71-year-old man with symptomatic AS, chronic kidney disease, and ischemic cardiomyopathy. The patient underwent multiple short ambulatory interventional radiology procedures. While moderate sedation with midazolam resulted in significant hypotension, use of remimazolam in subsequent procedures demonstrated a stable hemodynamic profile despite increased disease burden. This report highlights the potential advantages of remimazolam compared to midazolam in high-risk patients undergoing interventional radiology procedures.</p>","PeriodicalId":56372,"journal":{"name":"A&A practice","volume":"18 12","pages":"e01879"},"PeriodicalIF":0.5,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11636967/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803589","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The circle breathing system enables rebreathing using a carbon dioxide absorbent. This case report presents a rare incident of ventilation failure in a 30-year-old male patient due to a broken unidirectional valve in a soda lime canister. Despite the anesthesia machine passing automated checks, a mechanical blockage from caked soda lime in the inner inspiratory chamber led to insufficient tidal volume delivery. The incident underscores the importance of performing manual breathing circuit checks after replacing the soda lime canister, as well as the need for heightened vigilance in detecting equipment malfunctions to maintain patient safety during anesthesia.
{"title":"An Unusual Incident of \"Cannot Ventilate\" Situation Due to a Broken Soda Lime Canister: A Case Report.","authors":"Kanika Gupta, Priyanka Gupta, Saipavan Ganji, Bishnupriya Mohapatra","doi":"10.1213/XAA.0000000000001878","DOIUrl":"https://doi.org/10.1213/XAA.0000000000001878","url":null,"abstract":"<p><p>The circle breathing system enables rebreathing using a carbon dioxide absorbent. This case report presents a rare incident of ventilation failure in a 30-year-old male patient due to a broken unidirectional valve in a soda lime canister. Despite the anesthesia machine passing automated checks, a mechanical blockage from caked soda lime in the inner inspiratory chamber led to insufficient tidal volume delivery. The incident underscores the importance of performing manual breathing circuit checks after replacing the soda lime canister, as well as the need for heightened vigilance in detecting equipment malfunctions to maintain patient safety during anesthesia.</p>","PeriodicalId":56372,"journal":{"name":"A&A practice","volume":"18 12","pages":"e01878"},"PeriodicalIF":0.5,"publicationDate":"2024-12-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142803586","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}
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