Pub Date : 2017-02-15DOI: 10.1213/XAA.0000000000000430
Pregardien Caroline, N. Marie-Cécile, Yuksel Demet, Veyckemans Francis
In the absence of surgery on the urinary tract, the emission of red urine after anesthesia should be considered as a diagnostic emergency because it can be a sign of hematuria, hemoglobinuria, blood transfusion reaction, significant myoglobinuria, or porphyria.This case describes the management of a 12-year-old boy who presented red urine at the day care unit after strabismus surgery.
{"title":"Case Report: Red Urine After Day Care Strabismus Surgery.","authors":"Pregardien Caroline, N. Marie-Cécile, Yuksel Demet, Veyckemans Francis","doi":"10.1213/XAA.0000000000000430","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000430","url":null,"abstract":"In the absence of surgery on the urinary tract, the emission of red urine after anesthesia should be considered as a diagnostic emergency because it can be a sign of hematuria, hemoglobinuria, blood transfusion reaction, significant myoglobinuria, or porphyria.This case describes the management of a 12-year-old boy who presented red urine at the day care unit after strabismus surgery.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 3 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78384337","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 : 2017-02-15DOI: 10.1213/XAA.0000000000000429
H. Lenz, L. B. Stenseth, N. Meidell, H. Heimdal
A 34-year-old pregnant woman experienced cardiac arrest at home. Out-of-hospital perimortem cesarean delivery was performed 27 minutes after the collapse. Both mother and child were resuscitated and had return of spontaneous circulation before they were transported to a university hospital. The mother underwent hysterectomy and developed disseminated intravascular coagulation. Despite intensive treatment, she died 8.5 hours after arrival. The infant was extubated the next day, and her subsequent hospital course was uneventful. She was later diagnosed with cerebral palsy and severe gastroesophageal reflux. At 2 years of age, she communicated by sounds, eye contact, and smiling.
{"title":"Out-of-Hospital Perimortem Cesarean Delivery Performed in a Woman at 32 Weeks of Gestation: A Case Report.","authors":"H. Lenz, L. B. Stenseth, N. Meidell, H. Heimdal","doi":"10.1213/XAA.0000000000000429","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000429","url":null,"abstract":"A 34-year-old pregnant woman experienced cardiac arrest at home. Out-of-hospital perimortem cesarean delivery was performed 27 minutes after the collapse. Both mother and child were resuscitated and had return of spontaneous circulation before they were transported to a university hospital. The mother underwent hysterectomy and developed disseminated intravascular coagulation. Despite intensive treatment, she died 8.5 hours after arrival. The infant was extubated the next day, and her subsequent hospital course was uneventful. She was later diagnosed with cerebral palsy and severe gastroesophageal reflux. At 2 years of age, she communicated by sounds, eye contact, and smiling.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"8 4 1","pages":"72-74"},"PeriodicalIF":0.0,"publicationDate":"2017-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74614239","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 : 2017-02-15DOI: 10.1213/XAA.0000000000000428
Lauren M Parker, M. Yazer, J. Waters
Intraoperative cell salvage, whereby shed surgical blood is recovered for autologous reinfusion, is frequently used during hip arthroplasty because of the potential for significant blood loss. The following cases describe 2 instances in which chromium and cobalt particles from patients' metal-on-metal hip implants were identified within the blood recovery system. Results of heavy metal testing during the second case suggest that the use of a leukocyte reduction filter effectively reduces metal concentrations to below normal circulating levels. However, the reinfusion of cell salvage blood containing obvious metallic particles cannot be recommended until the effectiveness of leukocyte reduction filters in removing heavy metals has been further tested.
{"title":"Metallosis Identified via Intraoperative Cell Salvage: A Case Report.","authors":"Lauren M Parker, M. Yazer, J. Waters","doi":"10.1213/XAA.0000000000000428","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000428","url":null,"abstract":"Intraoperative cell salvage, whereby shed surgical blood is recovered for autologous reinfusion, is frequently used during hip arthroplasty because of the potential for significant blood loss. The following cases describe 2 instances in which chromium and cobalt particles from patients' metal-on-metal hip implants were identified within the blood recovery system. Results of heavy metal testing during the second case suggest that the use of a leukocyte reduction filter effectively reduces metal concentrations to below normal circulating levels. However, the reinfusion of cell salvage blood containing obvious metallic particles cannot be recommended until the effectiveness of leukocyte reduction filters in removing heavy metals has been further tested.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"20 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73447063","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 : 2017-02-15DOI: 10.1213/XAA.0000000000000435
A. Farag, Justin Tsai, S. Deeb, Deidre Putman-Garcia, J. Wasnick, L. Conlay
A 52-year-old woman, ASA II (American Society of Anesthesia classification II) scheduled for cholecystectomy in an ambulatory center, exhibited a wide-complex tachycardia with ectopy on the monitor after induction with propofol and succinylcholine. Blood pressure remained stable; amiodarone was administered for presumed ventricular tachycardia. A 12-lead electrocardiogram (ECG) showed a new left bundle branch block (LBBB) at 98 beats per minute (bpm), which resolved when the heart rate slowed. Surgery was postponed, and both the LBBB and ectopy recurred frequently during the next 24 hours in the intensive care unit, particularly at heart rates >90 bpm. Troponins were normal, and the patient was diagnosed with a rate-dependent LBBB and cleared for surgery.
{"title":"Rate-Dependent Left Bundle Branch Block in an Ambulatory Surgery Patient: A Case Report.","authors":"A. Farag, Justin Tsai, S. Deeb, Deidre Putman-Garcia, J. Wasnick, L. Conlay","doi":"10.1213/XAA.0000000000000435","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000435","url":null,"abstract":"A 52-year-old woman, ASA II (American Society of Anesthesia classification II) scheduled for cholecystectomy in an ambulatory center, exhibited a wide-complex tachycardia with ectopy on the monitor after induction with propofol and succinylcholine. Blood pressure remained stable; amiodarone was administered for presumed ventricular tachycardia. A 12-lead electrocardiogram (ECG) showed a new left bundle branch block (LBBB) at 98 beats per minute (bpm), which resolved when the heart rate slowed. Surgery was postponed, and both the LBBB and ectopy recurred frequently during the next 24 hours in the intensive care unit, particularly at heart rates >90 bpm. Troponins were normal, and the patient was diagnosed with a rate-dependent LBBB and cleared for surgery.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"3 1","pages":"81-85"},"PeriodicalIF":0.0,"publicationDate":"2017-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86540636","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 : 2017-02-15DOI: 10.1213/XAA.0000000000000425
J. Wasnick
{"title":"Can Strategic Choices Keep Physician Anesthesiologists \"In the Room Where It Happens?\"","authors":"J. Wasnick","doi":"10.1213/XAA.0000000000000425","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000425","url":null,"abstract":"","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"87 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76582444","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 : 2017-02-15DOI: 10.1213/XAA.0000000000000426
Rhashedah A. Ekeoduru, M. Greives, Eric A Nesrsta
A former 25-week-old neonate presented at 34 weeks postconceptual age with necrotizing fasciitis and purpura fulminans because of Group B Streptococcus infection. He was septic and coagulopathic when he was intubated, and the endotracheal tube was secured with adhesives. When he subsequently developed large purpuric, bullous lesions on the face and neck, he presented to the operating room for excision and debridement of his facial lesions. No change was made in how the endotracheal tube was secured. Midprocedure, an unintentional extubation occurred. We describe how we subsequently secured the airway and make recommendations on how to avoid this problem in the future and for rescue preparation before the procedure.
{"title":"Challenging Airway Secondary to Purpura Fulminans With Face and Neck Bullae in a Premature Infant: A Case Report.","authors":"Rhashedah A. Ekeoduru, M. Greives, Eric A Nesrsta","doi":"10.1213/XAA.0000000000000426","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000426","url":null,"abstract":"A former 25-week-old neonate presented at 34 weeks postconceptual age with necrotizing fasciitis and purpura fulminans because of Group B Streptococcus infection. He was septic and coagulopathic when he was intubated, and the endotracheal tube was secured with adhesives. When he subsequently developed large purpuric, bullous lesions on the face and neck, he presented to the operating room for excision and debridement of his facial lesions. No change was made in how the endotracheal tube was secured. Midprocedure, an unintentional extubation occurred. We describe how we subsequently secured the airway and make recommendations on how to avoid this problem in the future and for rescue preparation before the procedure.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"32 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83174511","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 : 2017-02-01DOI: 10.1213/XAA.0000000000000436
B. Tolly, Jenna L Kosky, A. Koht, L. Hemmer
A healthy 26-year-old man with cerebral arteriovenous malformation underwent staged endovascular embolization with Onyx followed by awake craniotomy for resection. The perioperative course was complicated by tachycardia and severe intraoperative hypoxemia requiring significant oxygen supplementation. Postoperative chest computed tomography (CT) revealed hyperattenuating Onyx embolization material within the pulmonary vasculature, and an electrocardiogram indicated possible right heart strain, supporting clinically significant embolism. With awake arteriovenous malformation resection following adjunctive Onyx embolization becoming increasingly employed for lesions involving the eloquent cortex, anesthesiologists need to be aware of pulmonary migration of Onyx material as a potential contributor to significant perioperative hypoxemia.
{"title":"A Case Report of Onyx Pulmonary Arterial Embolism Contributing to Hypoxemia During Awake Craniotomy for Arteriovenous Malformation Resection.","authors":"B. Tolly, Jenna L Kosky, A. Koht, L. Hemmer","doi":"10.1213/XAA.0000000000000436","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000436","url":null,"abstract":"A healthy 26-year-old man with cerebral arteriovenous malformation underwent staged endovascular embolization with Onyx followed by awake craniotomy for resection. The perioperative course was complicated by tachycardia and severe intraoperative hypoxemia requiring significant oxygen supplementation. Postoperative chest computed tomography (CT) revealed hyperattenuating Onyx embolization material within the pulmonary vasculature, and an electrocardiogram indicated possible right heart strain, supporting clinically significant embolism. With awake arteriovenous malformation resection following adjunctive Onyx embolization becoming increasingly employed for lesions involving the eloquent cortex, anesthesiologists need to be aware of pulmonary migration of Onyx material as a potential contributor to significant perioperative hypoxemia.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"07 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80403554","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 : 2017-02-01DOI: 10.1213/XAA.0000000000000421
M. Joseph, M. Theroux, James J. Mooney, Shawn Falitz, B. Brandom, D. Byler
We present the novel case report of a child with hypotonia and dysmorphic features who developed malignant hyperthermia (MH) intraoperatively. Neurology workup revealed the presence of a known causative ryanodine receptor (RYR1) mutation for MH, c.7522C>T; p.R2508C. Furthermore, the neurology workup diagnosed the child with King-Denborough syndrome (KDS). This particular mutation has never been documented in a patient with KDS. Atypical presentation of MH is more likely in patients with RYR1-related myopathy. A high index of suspicion for MH in children with myopathy is important. The MH hotline was helpful in the management of this patient when it was called after the initial dose of dantrolene. A neurology consult was essential for the diagnosis of KDS and future care.
{"title":"Intraoperative Presentation of Malignant Hyperthermia (Confirmed by RYR1 Gene Mutation, c.7522C>T; p.R2508C) Leads to Diagnosis of King-Denborough Syndrome in a Child With Hypotonia and Dysmorphic Features: A Case Report.","authors":"M. Joseph, M. Theroux, James J. Mooney, Shawn Falitz, B. Brandom, D. Byler","doi":"10.1213/XAA.0000000000000421","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000421","url":null,"abstract":"We present the novel case report of a child with hypotonia and dysmorphic features who developed malignant hyperthermia (MH) intraoperatively. Neurology workup revealed the presence of a known causative ryanodine receptor (RYR1) mutation for MH, c.7522C>T; p.R2508C. Furthermore, the neurology workup diagnosed the child with King-Denborough syndrome (KDS). This particular mutation has never been documented in a patient with KDS. Atypical presentation of MH is more likely in patients with RYR1-related myopathy. A high index of suspicion for MH in children with myopathy is important. The MH hotline was helpful in the management of this patient when it was called after the initial dose of dantrolene. A neurology consult was essential for the diagnosis of KDS and future care.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"24 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74594732","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 : 2017-02-01DOI: 10.1213/XAA.0000000000000434
J. Cormack, Jarrod Gott, Sarah Kondogiannis
{"title":"Profound Hypopnea With Xenon Anesthesia in a Free Diver.","authors":"J. Cormack, Jarrod Gott, Sarah Kondogiannis","doi":"10.1213/XAA.0000000000000434","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000434","url":null,"abstract":"","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"94 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83496862","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 : 2017-02-01DOI: 10.1213/XAA.0000000000000422
A. H. Couto, Hugo C. T. Siqueira, P. Brasileiro, I. Cavalcanti, R. Videira
Mesenteric traction syndrome is defined as arterial hypotension, facial flushing, and tachycardia related to mesenteric traction. We describe a case of mesenteric traction syndrome refractory to catecholamine and vasopressin infusions. The patient, who had Crohn disease, developed severe distributive shock after mesenteric traction while undergoing resection of an intestinal inflammatory mass, accompanied by facial flushing and unaltered readings for pulse oximetry, capnography, and bispectral index monitoring. The absence of tachycardia in this case was attributed to long-term use of timolol. Arterial pressure returned to baseline level after approximately 30 minutes, and the postoperative period was uneventful.
{"title":"Severe Intraoperative Shock Related to Mesenteric Traction Syndrome.","authors":"A. H. Couto, Hugo C. T. Siqueira, P. Brasileiro, I. Cavalcanti, R. Videira","doi":"10.1213/XAA.0000000000000422","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000422","url":null,"abstract":"Mesenteric traction syndrome is defined as arterial hypotension, facial flushing, and tachycardia related to mesenteric traction. We describe a case of mesenteric traction syndrome refractory to catecholamine and vasopressin infusions. The patient, who had Crohn disease, developed severe distributive shock after mesenteric traction while undergoing resection of an intestinal inflammatory mass, accompanied by facial flushing and unaltered readings for pulse oximetry, capnography, and bispectral index monitoring. The absence of tachycardia in this case was attributed to long-term use of timolol. Arterial pressure returned to baseline level after approximately 30 minutes, and the postoperative period was uneventful.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80137900","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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