Pub Date : 2017-05-01DOI: 10.1213/XAA.0000000000000475
Scott M. Wasilko, C. Giordano
{"title":"Operating Room Management and the Business of Anesthesia: Innovative Solutions to Bridge the Educational Gap in Residency Training Programs.","authors":"Scott M. Wasilko, C. Giordano","doi":"10.1213/XAA.0000000000000475","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000475","url":null,"abstract":"","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"48 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81502132","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 : 2017-05-01DOI: 10.1213/XAA.0000000000000473
Michael Dorbad, John Han, Shaik Ahmed, Brian R. Monroe, M. Entrup
We report a patient who developed a positional headache and pseudomeningocele after multiple lumbar surgeries for low back and radicular pain. An epidural blood patch via a lumbar approach was not feasible as a result of distorted lumbar anatomy after multiple back surgeries. An epidural blood patch was performed via catheter-threaded cephalad from a caudal approach. The patient had immediate relief after the procedure and at 1 year was still symptom-free. This combination technique may be considered as an alternative approach when a percutaneous lumbar epidural blood patch is disadvantageous.
{"title":"Lumbar Epidural Blood Patch via a Caudal Catheter After Surgical Dural Tear and Failed Repair: A Case Report","authors":"Michael Dorbad, John Han, Shaik Ahmed, Brian R. Monroe, M. Entrup","doi":"10.1213/XAA.0000000000000473","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000473","url":null,"abstract":"We report a patient who developed a positional headache and pseudomeningocele after multiple lumbar surgeries for low back and radicular pain. An epidural blood patch via a lumbar approach was not feasible as a result of distorted lumbar anatomy after multiple back surgeries. An epidural blood patch was performed via catheter-threaded cephalad from a caudal approach. The patient had immediate relief after the procedure and at 1 year was still symptom-free. This combination technique may be considered as an alternative approach when a percutaneous lumbar epidural blood patch is disadvantageous.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"50 1","pages":"229–231"},"PeriodicalIF":0.0,"publicationDate":"2017-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78522506","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 : 2017-04-15DOI: 10.1213/XAA.0000000000000462
Chyongjy Liu, Anica Crnkovic, J. Dalfino, Leina Yoko Singh
Parkinsonism-hyperpyrexia syndrome (PHS) is a neurologic emergency associated with anti- Parkinson medication withdrawal; however, its clinical presentation mimics sepsis. We describe the case of a 69-year-old man with advanced Parkinson disease who presented for exchange of the depleted battery in his subthalamic deep brain stimulator. The patient's preoperative symptoms of fever, rigidity, altered consciousness, and autonomic instability presented a dilemma whether to proceed with battery exchange to treat PHS or postpone surgery due to potential sepsis. The administration of dopaminergic medications, dantrolene, and antipyretic drugs are temporary supportive measures, while prompt restoration of deep brain stimulator function is the most important therapeutic treatment for PHS.
{"title":"Whether to Proceed With Deep Brain Stimulator Battery Change in a Patient With Signs of Potential Sepsis and Parkinson Hyperpyrexia Syndrome: A Case Report.","authors":"Chyongjy Liu, Anica Crnkovic, J. Dalfino, Leina Yoko Singh","doi":"10.1213/XAA.0000000000000462","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000462","url":null,"abstract":"Parkinsonism-hyperpyrexia syndrome (PHS) is a neurologic emergency associated with anti- Parkinson medication withdrawal; however, its clinical presentation mimics sepsis. We describe the case of a 69-year-old man with advanced Parkinson disease who presented for exchange of the depleted battery in his subthalamic deep brain stimulator. The patient's preoperative symptoms of fever, rigidity, altered consciousness, and autonomic instability presented a dilemma whether to proceed with battery exchange to treat PHS or postpone surgery due to potential sepsis. The administration of dopaminergic medications, dantrolene, and antipyretic drugs are temporary supportive measures, while prompt restoration of deep brain stimulator function is the most important therapeutic treatment for PHS.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"183 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74641701","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 : 2017-04-15DOI: 10.1213/XAA.0000000000000466
D. White, F. Lytle
A woman underwent ascending aortic aneurysm repair, aortic root and valve replacement, and coronary artery bypass grafting. Her postoperative course was complicated by stroke and status epilepticus. With supportive care and antiepileptics, her neurologic status improved. Intravenous heparin and aspirin were initiated. On postoperative day 13, she developed a large retroperitoneal hematoma with femoral neuropathy. Because her hematoma was not amenable to percutaneous drainage or surgical evacuation, and considering her comorbidities, a conservative approach was elected. Anticoagulation was held but not reversed, and she was transfused. Her impairment resolved fully after 3 days, and anticoagulation was restarted in staggered fashion.
{"title":"Femoral Neuropathy Following Spontaneous Retroperitoneal Hemorrhage After Cardiac Surgery: A Case Report.","authors":"D. White, F. Lytle","doi":"10.1213/XAA.0000000000000466","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000466","url":null,"abstract":"A woman underwent ascending aortic aneurysm repair, aortic root and valve replacement, and coronary artery bypass grafting. Her postoperative course was complicated by stroke and status epilepticus. With supportive care and antiepileptics, her neurologic status improved. Intravenous heparin and aspirin were initiated. On postoperative day 13, she developed a large retroperitoneal hematoma with femoral neuropathy. Because her hematoma was not amenable to percutaneous drainage or surgical evacuation, and considering her comorbidities, a conservative approach was elected. Anticoagulation was held but not reversed, and she was transfused. Her impairment resolved fully after 3 days, and anticoagulation was restarted in staggered fashion.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86127311","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 : 2017-04-15DOI: 10.1213/XAA.0000000000000468
S. Patel, Raymond M Evans, R. G. Garcia Getting, P. Suz
Postoperative nausea, vomiting, and pain present considerable concerns after reconstructive breast surgery. We present a case report of a 65-year-old woman with a history of severe postoperative nausea and vomiting, presenting for unilateral mastectomy with transverse rectus abdominis muscle flap. We performed unilateral pectoral nerve block and transverse abdominis plane block, which provided 24 hours of pain control and mitigated nausea and vomiting during the postoperative period.
{"title":"Pectoral Nerve and Transverse Abdominis Plane Block in a Patient Undergoing Mastectomy With Transverse Rectus Abdominis Muscle Flap: A Case Report.","authors":"S. Patel, Raymond M Evans, R. G. Garcia Getting, P. Suz","doi":"10.1213/XAA.0000000000000468","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000468","url":null,"abstract":"Postoperative nausea, vomiting, and pain present considerable concerns after reconstructive breast surgery. We present a case report of a 65-year-old woman with a history of severe postoperative nausea and vomiting, presenting for unilateral mastectomy with transverse rectus abdominis muscle flap. We performed unilateral pectoral nerve block and transverse abdominis plane block, which provided 24 hours of pain control and mitigated nausea and vomiting during the postoperative period.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"29 1","pages":"210-212"},"PeriodicalIF":0.0,"publicationDate":"2017-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73203334","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 : 2017-04-15DOI: 10.1213/XAA.0000000000000465
B. Tezcan, Demet Bölükbaşı, D. Kazancı, S. Turan, Gülseren Suer Kaya, A. Özgök
Sugammadex encapsulates and inactivates rocuronium and vecuronium. It is used to reverse neuromuscular blockade from these nondepolarizing agents. The safety of sugammadex in patients with neuromuscular disease has not been established. Guillain–Barre Syndrome (GBS) is a neuromuscular disease characterized by acute inflammatory polyneuropathy. Patients with GBS may exhibit autonomic dysfunction, chronic pain, abnormal reactions to neuromuscular blocking agents, and may require postoperative mechanical ventilation. We report the successful use of sugammadex to reverse rocuronium in a patient with chronic GBS, who presented for a hemicolectomy.
{"title":"The Use of Sugammadex in a Patient With Guillain–Barre Syndrome: A Case Report","authors":"B. Tezcan, Demet Bölükbaşı, D. Kazancı, S. Turan, Gülseren Suer Kaya, A. Özgök","doi":"10.1213/XAA.0000000000000465","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000465","url":null,"abstract":"Sugammadex encapsulates and inactivates rocuronium and vecuronium. It is used to reverse neuromuscular blockade from these nondepolarizing agents. The safety of sugammadex in patients with neuromuscular disease has not been established. Guillain–Barre Syndrome (GBS) is a neuromuscular disease characterized by acute inflammatory polyneuropathy. Patients with GBS may exhibit autonomic dysfunction, chronic pain, abnormal reactions to neuromuscular blocking agents, and may require postoperative mechanical ventilation. We report the successful use of sugammadex to reverse rocuronium in a patient with chronic GBS, who presented for a hemicolectomy.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"6 1","pages":"200–202"},"PeriodicalIF":0.0,"publicationDate":"2017-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88549546","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 : 2017-04-15DOI: 10.1213/XAA.0000000000000469
Timothy J. Del Rosario, Mafdy N. Basta, Shvetank Agarwal
A 35-year-old morbidly obese woman with a history of deep vein thrombosis and pulmonary embolism presented for right atrial thrombectomy via AngioVac suction system. A portion of the thrombus could not be suctioned into the AngioVac cannula, leading to fragmentation and distal embolization with hemodynamic collapse. This sequence, observed in real time under transesophageal echocardiography, also demonstrated that the clot had echocardiographic features of chronicity. A well-organized chronic clot may be more difficult to extract via this method, leading to the complication described. With increasing popularity of this less invasive method, further investigation to understand the indications and contraindications is warranted.
{"title":"AngioVac Suction Thrombectomy Complicated by Thrombus Fragmentation and Distal Embolization Leading to Hemodynamic Collapse: A Case Report","authors":"Timothy J. Del Rosario, Mafdy N. Basta, Shvetank Agarwal","doi":"10.1213/XAA.0000000000000469","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000469","url":null,"abstract":"A 35-year-old morbidly obese woman with a history of deep vein thrombosis and pulmonary embolism presented for right atrial thrombectomy via AngioVac suction system. A portion of the thrombus could not be suctioned into the AngioVac cannula, leading to fragmentation and distal embolization with hemodynamic collapse. This sequence, observed in real time under transesophageal echocardiography, also demonstrated that the clot had echocardiographic features of chronicity. A well-organized chronic clot may be more difficult to extract via this method, leading to the complication described. With increasing popularity of this less invasive method, further investigation to understand the indications and contraindications is warranted.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"43 1","pages":"206–209"},"PeriodicalIF":0.0,"publicationDate":"2017-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79379148","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 : 2017-04-15DOI: 10.1213/XAA.0000000000000467
J. Chao, C. Liu, N. Shetty, Ushma Shah
Cerebellar mutism syndrome (CMS) is a common complication of posterior fossa surgery that can confound the postanesthetic examination and have long-lasting impacts. There is confusion surrounding its precise description, diagnostic features, and associated morbidity. Here, we discuss the most up-to-date knowledge of CMS drawing from a clinical case in the context of 3 new reports: (1) an international consensus paper presenting a new proposed working definition by the Iceland Delphi Group, (2) a knowledge update by Gadgil et al, (3) and a review of neuroimaging-based data elucidating the etiology of CMS by Patay.
{"title":"Postoperative Pediatric Cerebellar Mutism After Posterior Fossa Surgery: A Case Report.","authors":"J. Chao, C. Liu, N. Shetty, Ushma Shah","doi":"10.1213/XAA.0000000000000467","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000467","url":null,"abstract":"Cerebellar mutism syndrome (CMS) is a common complication of posterior fossa surgery that can confound the postanesthetic examination and have long-lasting impacts. There is confusion surrounding its precise description, diagnostic features, and associated morbidity. Here, we discuss the most up-to-date knowledge of CMS drawing from a clinical case in the context of 3 new reports: (1) an international consensus paper presenting a new proposed working definition by the Iceland Delphi Group, (2) a knowledge update by Gadgil et al, (3) and a review of neuroimaging-based data elucidating the etiology of CMS by Patay.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"31 1","pages":"213-215"},"PeriodicalIF":0.0,"publicationDate":"2017-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90109803","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 : 2017-04-01DOI: 10.1213/XAA.0000000000000455
Gregory J. Blair, R. Hsiung
Esophageal "bougie" dilators are frequently used during esophageal surgeries to facilitate reconstruction and manipulation of the esophagus. Insertion of such dilators is usually a blind technique and not without risk. We present a case of retropharyngeal wall perforation resulting from esophageal dilator misplacement in a patient undergoing laparoscopic Heller myotomy and reconstruction. This case report demonstrates the importance of communication between surgery and anesthesiology teams during placement of devices into the oropharynx.
{"title":"Retropharyngeal Perforation With an Esophageal Dilator: A Case Report.","authors":"Gregory J. Blair, R. Hsiung","doi":"10.1213/XAA.0000000000000455","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000455","url":null,"abstract":"Esophageal \"bougie\" dilators are frequently used during esophageal surgeries to facilitate reconstruction and manipulation of the esophagus. Insertion of such dilators is usually a blind technique and not without risk. We present a case of retropharyngeal wall perforation resulting from esophageal dilator misplacement in a patient undergoing laparoscopic Heller myotomy and reconstruction. This case report demonstrates the importance of communication between surgery and anesthesiology teams during placement of devices into the oropharynx.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78767340","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 : 2017-04-01DOI: 10.1213/XAA.0000000000000451
Tomohiro Yamamoto, M. Schmidt-Niemann, E. Schindler
We report a rare case of an infant with both an aneurysmal dilation of the patent ductus arteriosus (PDA) and bilateral congenital iris sphincter agenesis. Her mydriasis without pupillary light reflex was first noted after a massive intraoperative bleeding episode during the PDA ligation. The assumption that the mydriasis was a sign of cerebral ischemia led to additional examinations and intensive medical therapies that in retrospect were unnecessary. This is the first reported case of combined aneurysmal dilation of a PDA and congenital iris sphincter agenesis in the anesthesia literature.
{"title":"Bilateral Congenital Iris Sphincter Agenesis Diagnosed After Massive Bleeding Episode During Repair of Aneurysmal Dilation of Patent Ductus Arteriosus: A Case Report.","authors":"Tomohiro Yamamoto, M. Schmidt-Niemann, E. Schindler","doi":"10.1213/XAA.0000000000000451","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000451","url":null,"abstract":"We report a rare case of an infant with both an aneurysmal dilation of the patent ductus arteriosus (PDA) and bilateral congenital iris sphincter agenesis. Her mydriasis without pupillary light reflex was first noted after a massive intraoperative bleeding episode during the PDA ligation. The assumption that the mydriasis was a sign of cerebral ischemia led to additional examinations and intensive medical therapies that in retrospect were unnecessary. This is the first reported case of combined aneurysmal dilation of a PDA and congenital iris sphincter agenesis in the anesthesia literature.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"8 3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78436176","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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