Pub Date : 2017-03-01DOI: 10.1213/XAA.0000000000000440
Seiko Sato, E. Nakamori, G. Kusumoto, K. Shigematsu, K. Yamaura
A 28-year-old woman with preeclampsia at 32 weeks of gestation underwent a cesarean delivery under spinal anesthesia. Administration of nitroglycerin at 200 μg to relax uterine smooth muscles and the application of fundal pressure led to severe bradycardia and loss of consciousness, followed by cardiac arrest. Delivery was completed immediately and recovery was achieved 10 seconds later following cardiopulmonary resuscitation. Neurally mediated syncope was considered the cause of cardiac arrest. Anesthetists should be aware of the potential risk during cesarean delivery following the administration of nitroglycerin, fundal pressure, regional anesthesia, and hypovolemia because of preeclampsia.
{"title":"Neurally Mediated Syncope During Cesarean Delivery: A Case Report.","authors":"Seiko Sato, E. Nakamori, G. Kusumoto, K. Shigematsu, K. Yamaura","doi":"10.1213/XAA.0000000000000440","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000440","url":null,"abstract":"A 28-year-old woman with preeclampsia at 32 weeks of gestation underwent a cesarean delivery under spinal anesthesia. Administration of nitroglycerin at 200 μg to relax uterine smooth muscles and the application of fundal pressure led to severe bradycardia and loss of consciousness, followed by cardiac arrest. Delivery was completed immediately and recovery was achieved 10 seconds later following cardiopulmonary resuscitation. Neurally mediated syncope was considered the cause of cardiac arrest. Anesthetists should be aware of the potential risk during cesarean delivery following the administration of nitroglycerin, fundal pressure, regional anesthesia, and hypovolemia because of preeclampsia.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"36 1","pages":"96-99"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75135946","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 : 2017-03-01DOI: 10.1213/XAA.0000000000000441
C. Padilla, Antonio Hernandez Conte, D. Ramzy, Lorraine Lubin, Troy Labounty, J. Chung, Ying Zeng
Parturients may present with evidence of acute heart failure or respiratory distress during the peripartum period. This case report documents utilization of "stand-by" extracorporeal membrane oxygenation (ECMO) for a 40-year-old woman with a history of severe left ventricular dysfunction who presented for elective dilation and evacuation of triplets at 20 weeks' gestation. The patient's medical history was significant for hypertension, diabetes mellitus, methamphetamine use (acute/chronic), and cardiac-respiratory arrest before her previous emergent cesarean delivery. The patient underwent general anesthesia with the placement of peripheral venous and arterial cannulas for "stand-by" ECMO. The patient remained stable throughout the procedure, and "stand-by" ECMO was not initiated; the patient was discharged 5 days' postprocedure. The use of "stand-by" ECMO in the parturient with severe cardiopulmonary dysfunction is still in its infancy. Centers managing populations of both high-risk parturients and nonparturients may consider development of algorithms for implementation and utilization of ECMO.
{"title":"Utilization of \"Stand-By\" Extracorporeal Membrane Oxygenation in a High-Risk Parturient With Methamphetamine-Associated Cardiomyopathy Undergoing Dilation and Evacuation: A Case Report.","authors":"C. Padilla, Antonio Hernandez Conte, D. Ramzy, Lorraine Lubin, Troy Labounty, J. Chung, Ying Zeng","doi":"10.1213/XAA.0000000000000441","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000441","url":null,"abstract":"Parturients may present with evidence of acute heart failure or respiratory distress during the peripartum period. This case report documents utilization of \"stand-by\" extracorporeal membrane oxygenation (ECMO) for a 40-year-old woman with a history of severe left ventricular dysfunction who presented for elective dilation and evacuation of triplets at 20 weeks' gestation. The patient's medical history was significant for hypertension, diabetes mellitus, methamphetamine use (acute/chronic), and cardiac-respiratory arrest before her previous emergent cesarean delivery. The patient underwent general anesthesia with the placement of peripheral venous and arterial cannulas for \"stand-by\" ECMO. The patient remained stable throughout the procedure, and \"stand-by\" ECMO was not initiated; the patient was discharged 5 days' postprocedure. The use of \"stand-by\" ECMO in the parturient with severe cardiopulmonary dysfunction is still in its infancy. Centers managing populations of both high-risk parturients and nonparturients may consider development of algorithms for implementation and utilization of ECMO.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"50 1","pages":"105-108"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85207040","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 : 2017-03-01DOI: 10.1213/XAA.0000000000000433
N. Gupta, P. Sahoo, K. Madan, S. Bharti
Posttracheostomy tracheal stenosis is a rare complication of prolonged tracheal intubation. Treatment modalities that may be used include surgical resection and anastomosis, endoscopic tracheal dilation, laser resection, and tracheal stenting. We describe a novel salvage modality for dilation of a symptomatic tracheal stenosis using a percutaneous tracheostomy dilator wherein rigid bronchoscopic dilation was not feasible and balloon tracheal dilation had failed.
{"title":"Fiberoptic-Guided Blue Rhino Dilator-Assisted Dilation of Postintubation Tracheal Stenosis: A Case Report About a Novel Technique.","authors":"N. Gupta, P. Sahoo, K. Madan, S. Bharti","doi":"10.1213/XAA.0000000000000433","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000433","url":null,"abstract":"Posttracheostomy tracheal stenosis is a rare complication of prolonged tracheal intubation. Treatment modalities that may be used include surgical resection and anastomosis, endoscopic tracheal dilation, laser resection, and tracheal stenting. We describe a novel salvage modality for dilation of a symptomatic tracheal stenosis using a percutaneous tracheostomy dilator wherein rigid bronchoscopic dilation was not feasible and balloon tracheal dilation had failed.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"129 1","pages":"136-138"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79575140","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 : 2017-03-01DOI: 10.1213/XAA.0000000000000443
A. M. Baciewicz, Calvin Lee, A. Ben-Ari, Hojoong Kim, Alex T Lee
Anticoagulation after a recent neuraxial procedure poses risk for development of spinal hematoma. Clinical evidence supports prompt IV tissue plasminogen activator administration after onset of ischemic stroke. There is an absence of data regarding emergency fibrinolytic therapy for patients experiencing a stroke with recent neuraxial procedures, resulting in highly disparate, nonevidence-based guidelines. This report describes a patient who developed ischemic stroke when receiving postoperative epidural analgesia. Tissue plasminogen activator was emergently administered 1 hour after epidural catheter removal with a favorable recovery. The patient and his family reviewed the manuscript, and written consent to publish this case report was obtained from the patient.
{"title":"Intravenous Tissue Plasminogen Activator Administration for Ischemic Stroke 1 Hour After Epidural Catheter Removal: A Case Report.","authors":"A. M. Baciewicz, Calvin Lee, A. Ben-Ari, Hojoong Kim, Alex T Lee","doi":"10.1213/XAA.0000000000000443","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000443","url":null,"abstract":"Anticoagulation after a recent neuraxial procedure poses risk for development of spinal hematoma. Clinical evidence supports prompt IV tissue plasminogen activator administration after onset of ischemic stroke. There is an absence of data regarding emergency fibrinolytic therapy for patients experiencing a stroke with recent neuraxial procedures, resulting in highly disparate, nonevidence-based guidelines. This report describes a patient who developed ischemic stroke when receiving postoperative epidural analgesia. Tissue plasminogen activator was emergently administered 1 hour after epidural catheter removal with a favorable recovery. The patient and his family reviewed the manuscript, and written consent to publish this case report was obtained from the patient.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"28 1","pages":"113-115"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89455226","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 : 2017-03-01DOI: 10.1213/XAA.0000000000000446
Yuri Koumpan, J. Murdoch, J. Beyea, M. Kahn, Jaime Colbeck
Airway management in trauma is a crucial skill, because patients are at risk of aspiration, hypoxia, and hypoventilation, all of which may be fatal in the setting of increased intracranial pressure. The King Laryngeal Tube reusable supraglottic airway (King Systems, Noblesville, IN) allows for temporary management of a difficult airway but poses a challenge when an attempt is made to exchange the device for an endotracheal tube, often managed by emergency tracheostomy. We describe a novel fiberoptic, video laryngoscope-assisted approach to intubation in a difficult trauma airway with an in situ King Laryngeal Tube.
{"title":"A Case Report: Establishing a Definitive Airway in a Trauma Patient With a King Laryngeal Tube In Situ in the Presence of a Closed Head Injury and Difficult Airway: \"Between the Devil and the Deep Blue Sea\".","authors":"Yuri Koumpan, J. Murdoch, J. Beyea, M. Kahn, Jaime Colbeck","doi":"10.1213/XAA.0000000000000446","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000446","url":null,"abstract":"Airway management in trauma is a crucial skill, because patients are at risk of aspiration, hypoxia, and hypoventilation, all of which may be fatal in the setting of increased intracranial pressure. The King Laryngeal Tube reusable supraglottic airway (King Systems, Noblesville, IN) allows for temporary management of a difficult airway but poses a challenge when an attempt is made to exchange the device for an endotracheal tube, often managed by emergency tracheostomy. We describe a novel fiberoptic, video laryngoscope-assisted approach to intubation in a difficult trauma airway with an in situ King Laryngeal Tube.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"93 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80818802","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 : 2017-03-01DOI: 10.1213/XAA.0000000000000438
Ryan J Vealey, A. Koht, B. Bendok
In some cases of cerebral aneurysm clipping, direct clip application to the aneurysm neck may be difficult or the aneurysm may rupture unexpectedly. In these cases, a clip may be temporarily applied to the parent artery to reduce aneurysmal wall tension, facilitate permanent clip placement, or control bleeding if the aneurysm ruptures. In certain circumstances, even applying a temporary clip may be challenging. We present a case in which the aneurysm ruptured and IV administration of adenosine was required to facilitate clipping. This case suggests that administering multiple consecutive precalculated doses of adenosine may be a safe method to manage aneurysmal rupture.
{"title":"Multidose Adenosine Used to Facilitate Microsurgical Clipping of a Cerebral Aneurysm Complicated by Intraoperative Rupture: A Case Report.","authors":"Ryan J Vealey, A. Koht, B. Bendok","doi":"10.1213/XAA.0000000000000438","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000438","url":null,"abstract":"In some cases of cerebral aneurysm clipping, direct clip application to the aneurysm neck may be difficult or the aneurysm may rupture unexpectedly. In these cases, a clip may be temporarily applied to the parent artery to reduce aneurysmal wall tension, facilitate permanent clip placement, or control bleeding if the aneurysm ruptures. In certain circumstances, even applying a temporary clip may be challenging. We present a case in which the aneurysm ruptured and IV administration of adenosine was required to facilitate clipping. This case suggests that administering multiple consecutive precalculated doses of adenosine may be a safe method to manage aneurysmal rupture.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"55 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76400244","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 : 2017-03-01DOI: 10.1213/XAA.0000000000000450
L. Warner, D. Ekbom, P. Warner
Repeated ingestion of small objects has been previously reported in the psychiatric literature. We recently had a patient with repeated intentional foreign body ingestion syndrome who developed complete airway obstruction and cardiac arrest after ingesting a computer mouse tracking ball. We use our case to suggest a pathway that can be used for similar emergent airway problems.
{"title":"The Extraordinary Case of the Hungry Woman: Large Foreign Body Ingestion With Respiratory Arrest.","authors":"L. Warner, D. Ekbom, P. Warner","doi":"10.1213/XAA.0000000000000450","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000450","url":null,"abstract":"Repeated ingestion of small objects has been previously reported in the psychiatric literature. We recently had a patient with repeated intentional foreign body ingestion syndrome who developed complete airway obstruction and cardiac arrest after ingesting a computer mouse tracking ball. We use our case to suggest a pathway that can be used for similar emergent airway problems.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87144627","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 : 2017-03-01DOI: 10.1213/XAA.0000000000000404
K. Imai, T. Doi, K. Kayashima
We experienced difficulty inserting cuffed inner diameter (ID) 4.5- and 5.0-mm endotracheal tubes (ETTs) in a 5-year-old boy. Postoperative ultrasound investigations showed that the internal transverse width of the cricoid cartilage was 8.0 mm. The maximum outer diameter (OD) of the deflated cuff portion of the cuffed ID 4.5- and 5.0-mm ETTs was 8.5 and 9.6 mm, respectively. The OD of an uncuffed ID 5.5-mm ETT was 7.6 mm; this tube passed the cricoid cartilage. Hence, the transverse width of the cricoid cartilage and ETT diameter including cuff folds should be considered when selecting cuffed ETTs.
{"title":"Difficulty Inserting Cuffed Endotracheal Tubes in a Child: A Case Report.","authors":"K. Imai, T. Doi, K. Kayashima","doi":"10.1213/XAA.0000000000000404","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000404","url":null,"abstract":"We experienced difficulty inserting cuffed inner diameter (ID) 4.5- and 5.0-mm endotracheal tubes (ETTs) in a 5-year-old boy. Postoperative ultrasound investigations showed that the internal transverse width of the cricoid cartilage was 8.0 mm. The maximum outer diameter (OD) of the deflated cuff portion of the cuffed ID 4.5- and 5.0-mm ETTs was 8.5 and 9.6 mm, respectively. The OD of an uncuffed ID 5.5-mm ETT was 7.6 mm; this tube passed the cricoid cartilage. Hence, the transverse width of the cricoid cartilage and ETT diameter including cuff folds should be considered when selecting cuffed ETTs.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73682388","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 : 2017-03-01DOI: 10.1213/XAA.0000000000000439
Yuriko Samejima, M. Kodaka, J. Ichikawa, Tetsu Mori, K. Ando, K. Nishiyama, M. Komori
A 72-year-old woman with antiphospholipid syndrome underwent aortic valve replacement. Her preoperative activated partial thromboplastin time was 61.7 seconds and activated clotting time was 219 seconds. During cardiopulmonary bypass, the Hepcon Hemostasis Management System (HMS) Plus determined the heparin dose needed to maintain whole-body heparin at 3 U/mL. After cardiopulmonary bypass, 100 mg of protamine was administered based on heparin-protamine neutralization, and the activated clotting time decreased. We applied rotational thromboelastometry (ROTEM) to diagnose residual heparin using the INTEM/HEPTEM clotting time ratio. The HMS and ROTEM are useful for heparin-protamine control in antiphospholipid syndrome.
{"title":"Management of a Patient With Antiphospholipid Syndrome Undergoing Aortic Valve Replacement Using the Hepcon Hemostasis Management System Plus and Rotational Thromboelastometry: A Case Report.","authors":"Yuriko Samejima, M. Kodaka, J. Ichikawa, Tetsu Mori, K. Ando, K. Nishiyama, M. Komori","doi":"10.1213/XAA.0000000000000439","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000439","url":null,"abstract":"A 72-year-old woman with antiphospholipid syndrome underwent aortic valve replacement. Her preoperative activated partial thromboplastin time was 61.7 seconds and activated clotting time was 219 seconds. During cardiopulmonary bypass, the Hepcon Hemostasis Management System (HMS) Plus determined the heparin dose needed to maintain whole-body heparin at 3 U/mL. After cardiopulmonary bypass, 100 mg of protamine was administered based on heparin-protamine neutralization, and the activated clotting time decreased. We applied rotational thromboelastometry (ROTEM) to diagnose residual heparin using the INTEM/HEPTEM clotting time ratio. The HMS and ROTEM are useful for heparin-protamine control in antiphospholipid syndrome.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"106 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76141469","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 : 2017-03-01DOI: 10.1213/XAA.0000000000000444
Masakazu Kotoda, T. Ishiyama, K. Okuyama, T. Matsukawa
Jeune syndrome is a rare autosomal-recessive skeletal disorder. Anesthetic management of these patients is often difficult because of thoracic and lung hypoplasia. A 5-month-old boy with Jeune syndrome was scheduled to undergo a tracheotomy. Despite 5-minute preoxygenation with continuous positive airway pressure, the patient’s oxygen saturation rapidly dropped during the induction of anesthesia. The continuous positive airway pressure should have been titrated to effective tidal volume during preoxygenation to recruit the patient’s functional residual capacity and to prevent desaturation. During tracheotomy, volume-controlled ventilation with a high respiratory rate and sufficient inspiratory time effectively improved the patient’s respiratory status.
{"title":"Anesthetic Management of a Child With Jeune Syndrome for Tracheotomy: A Case Report","authors":"Masakazu Kotoda, T. Ishiyama, K. Okuyama, T. Matsukawa","doi":"10.1213/XAA.0000000000000444","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000444","url":null,"abstract":"Jeune syndrome is a rare autosomal-recessive skeletal disorder. Anesthetic management of these patients is often difficult because of thoracic and lung hypoplasia. A 5-month-old boy with Jeune syndrome was scheduled to undergo a tracheotomy. Despite 5-minute preoxygenation with continuous positive airway pressure, the patient’s oxygen saturation rapidly dropped during the induction of anesthesia. The continuous positive airway pressure should have been titrated to effective tidal volume during preoxygenation to recruit the patient’s functional residual capacity and to prevent desaturation. During tracheotomy, volume-controlled ventilation with a high respiratory rate and sufficient inspiratory time effectively improved the patient’s respiratory status.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"8 1","pages":"119–121"},"PeriodicalIF":0.0,"publicationDate":"2017-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91387590","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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