Pub Date : 2017-01-15DOI: 10.1213/XAA.0000000000000416
Elliot Woodward, Zhilin Xiong
Provision of anesthesia for patients with mitochondrial disorders is associated with a unique set of challenges. These disorders are rare, which complicates efforts to develop high quality, evidence-based guidelines to inform the perioperative management of those who suffer from them. Accordingly, case reports remain an important source of information regarding their care. Here we present the case of a 27-year-old female patient with mitochondrial myopathy and a history suggestive of malignant hyperthermia susceptibility who received general anesthesia for 2 consecutive surgeries. The induction agents included fentanyl, ketamine, and methohexital. The maintenance agents were methohexital, sufentanil, and dexmedetomidine.
{"title":"Use of Methohexital and Dexmedetomidine for Maintenance of Anesthesia in a Patient With Mitochondrial Myopathy: A Case Report.","authors":"Elliot Woodward, Zhilin Xiong","doi":"10.1213/XAA.0000000000000416","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000416","url":null,"abstract":"Provision of anesthesia for patients with mitochondrial disorders is associated with a unique set of challenges. These disorders are rare, which complicates efforts to develop high quality, evidence-based guidelines to inform the perioperative management of those who suffer from them. Accordingly, case reports remain an important source of information regarding their care. Here we present the case of a 27-year-old female patient with mitochondrial myopathy and a history suggestive of malignant hyperthermia susceptibility who received general anesthesia for 2 consecutive surgeries. The induction agents included fentanyl, ketamine, and methohexital. The maintenance agents were methohexital, sufentanil, and dexmedetomidine.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"165 1","pages":"33-35"},"PeriodicalIF":0.0,"publicationDate":"2017-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73205903","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 : 2017-01-15DOI: 10.1213/XAA.0000000000000414
A. Hulst, Hans J. Avis, M. Hollmann, M. Stevens
A patient suffered massive subcutaneous emphysema and bilateral tension pneumothoraces after receiving supplemental oxygen through an airway exchange catheter (AEC). Complications of AEC placement include misplacement, direct injury to the larynx, bronchi or lung, barotrauma related to oxygen supplementation, and a loss of airway. We review these complications and discuss the specific risks of supplementing oxygen using an AEC. We suggest measures to limit pressure from the oxygen source and warn against advancing an AEC too far into the tracheobronchial tree.
{"title":"Massive Subcutaneous Emphysema and Bilateral Tension Pneumothoraces After Supplemental Oxygen Delivery via an Airway Exchange Catheter: A Case Report","authors":"A. Hulst, Hans J. Avis, M. Hollmann, M. Stevens","doi":"10.1213/XAA.0000000000000414","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000414","url":null,"abstract":"A patient suffered massive subcutaneous emphysema and bilateral tension pneumothoraces after receiving supplemental oxygen through an airway exchange catheter (AEC). Complications of AEC placement include misplacement, direct injury to the larynx, bronchi or lung, barotrauma related to oxygen supplementation, and a loss of airway. We review these complications and discuss the specific risks of supplementing oxygen using an AEC. We suggest measures to limit pressure from the oxygen source and warn against advancing an AEC too far into the tracheobronchial tree.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"12 1","pages":"26–28"},"PeriodicalIF":0.0,"publicationDate":"2017-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87578668","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 : 2017-01-15DOI: 10.1213/XAA.0000000000000417
K. Chaudhuri, Cooper Phillips, S. Chaudhuri, J. Wasnick
Compared to conventional therapy, several studies with prothrombin complex concentrate (PCC) have recently demonstrated its superior efficacy in rapidly replacing vitamin K-dependent factors for patients with life-threatening hemorrhage. We present a novel use of PCC in a patient with intracranial hypotension, who had received warfarin for treatment of cortical vein thrombosis. However, after anticoagulation, she proceeded to develop bilateral subdural hematomas with descent of cerebellar tonsils. Given the possibility of an occult dural puncture during labor analgesia, an epidural blood patch was performed after administration of PCC and normalization of coagulation parameters, with prompt improvement of the patient's headache.
{"title":"Use of Prothrombin Complex Concentrate for Warfarin Reversal Before the Performance of an Epidural Blood Patch in a Patient With Cortical Vein Thrombosis and Subdural Hematoma: A Case Report.","authors":"K. Chaudhuri, Cooper Phillips, S. Chaudhuri, J. Wasnick","doi":"10.1213/XAA.0000000000000417","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000417","url":null,"abstract":"Compared to conventional therapy, several studies with prothrombin complex concentrate (PCC) have recently demonstrated its superior efficacy in rapidly replacing vitamin K-dependent factors for patients with life-threatening hemorrhage. We present a novel use of PCC in a patient with intracranial hypotension, who had received warfarin for treatment of cortical vein thrombosis. However, after anticoagulation, she proceeded to develop bilateral subdural hematomas with descent of cerebellar tonsils. Given the possibility of an occult dural puncture during labor analgesia, an epidural blood patch was performed after administration of PCC and normalization of coagulation parameters, with prompt improvement of the patient's headache.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2017-01-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89518030","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 : 2017-01-01DOI: 10.1213/XAA.0000000000000408
Changsheng Zhang, M. Pirrone, D. Imber, J. Ackman, J. Fumagalli, R. Kacmarek, L. Berra
Morbidly obese, critically ill patients are prone to develop hypoxemic respiratory failure and ventilator dependency. The best method for recruiting the lungs of these patients and keeping alveoli open without causing injury remains unclear. We present the case of a 31-year-old patient with severe refractory hypoxemia reversed by lung recruitment maneuvers and subsequent application of positive end-expiratory pressure (PEEP) at a level determined by a decremental PEEP trial. The patient was extubated at a high PEEP level of 22 cm H2O followed by noninvasive ventilatory support after extubation. This case suggests that a recruitment maneuver followed by PEEP titration is necessary in obese patients for optimizing mechanical ventilation. Extubation to noninvasive ventilatory support with the identified optimal PEEP may decrease an inappropriate increased work of breathing and the risk of reintubation.
病态肥胖、危重患者易发生低氧性呼吸衰竭和呼吸机依赖。在不造成损伤的情况下，招募这些患者的肺并保持肺泡开放的最佳方法尚不清楚。我们报告了一例31岁的严重难治性低氧血症患者，通过肺补充操作和随后呼气末正压(PEEP)的应用，其水平由递减PEEP试验确定。患者在高PEEP 22 cm H2O时拔管，拔管后给予无创通气支持。本病例提示，在肥胖患者中，为了优化机械通气，有必要在呼气末正压滴定后进行复吸操作。用确定的最佳PEEP拔管至无创通气支持可能会减少不适当的增加的呼吸功和再插管的风险。
{"title":"Optimization of Mechanical Ventilation in a 31-Year-Old Morbidly Obese Man With Refractory Hypoxemia","authors":"Changsheng Zhang, M. Pirrone, D. Imber, J. Ackman, J. Fumagalli, R. Kacmarek, L. Berra","doi":"10.1213/XAA.0000000000000408","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000408","url":null,"abstract":"Morbidly obese, critically ill patients are prone to develop hypoxemic respiratory failure and ventilator dependency. The best method for recruiting the lungs of these patients and keeping alveoli open without causing injury remains unclear. We present the case of a 31-year-old patient with severe refractory hypoxemia reversed by lung recruitment maneuvers and subsequent application of positive end-expiratory pressure (PEEP) at a level determined by a decremental PEEP trial. The patient was extubated at a high PEEP level of 22 cm H2O followed by noninvasive ventilatory support after extubation. This case suggests that a recruitment maneuver followed by PEEP titration is necessary in obese patients for optimizing mechanical ventilation. Extubation to noninvasive ventilatory support with the identified optimal PEEP may decrease an inappropriate increased work of breathing and the risk of reintubation.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"33 1","pages":"7–10"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75119762","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 : 2017-01-01DOI: 10.1213/XAA.0000000000000513
{"title":"Crisis Management of Accidental Extubation in a Prone-Positioned Patient with Klippel-Feil Syndrome: Erratum.","authors":"","doi":"10.1213/XAA.0000000000000513","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000513","url":null,"abstract":"","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"38 1","pages":"91"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83138566","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 : 2017-01-01DOI: 10.1213/XAA.0000000000000419
Bradford B. Smith, Mark M. Smith, K. Rehfeldt
Iatrogenic occlusion of the right coronary artery (RCA) is a rare complication after tricuspid valve surgery. We review the case of a 74-year-old female who presented for mitral and tricuspid valve annuloplasty. Unanticipated postcardiopulmonary bypass biventricular hypokinesis was encountered, necessitating extracorporeal support. Emergent coronary angiography demonstrated near-complete RCA occlusion from a taut periarterial suture near the RCA. Deployment of a drug-eluting stent restored normal flow, and the patient made a full recovery. Although an exceedingly rare complication, iatrogenic RCA injury after tricuspid valve operations should be considered in the setting of unexpected ventricular compromise.
{"title":"Iatrogenic Right Coronary Artery Occlusion Following Tricuspid Valve Repair: Case Report of a Rare but Recognized Complication.","authors":"Bradford B. Smith, Mark M. Smith, K. Rehfeldt","doi":"10.1213/XAA.0000000000000419","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000419","url":null,"abstract":"Iatrogenic occlusion of the right coronary artery (RCA) is a rare complication after tricuspid valve surgery. We review the case of a 74-year-old female who presented for mitral and tricuspid valve annuloplasty. Unanticipated postcardiopulmonary bypass biventricular hypokinesis was encountered, necessitating extracorporeal support. Emergent coronary angiography demonstrated near-complete RCA occlusion from a taut periarterial suture near the RCA. Deployment of a drug-eluting stent restored normal flow, and the patient made a full recovery. Although an exceedingly rare complication, iatrogenic RCA injury after tricuspid valve operations should be considered in the setting of unexpected ventricular compromise.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"8 1","pages":"39-41"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83422596","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 : 2017-01-01DOI: 10.1213/XAA.0000000000000406
L. La Colla, B. Ben-david, Rita B Merman
Quadratus lumborum (QL) block was first described several years ago, but few articles have been published regarding this technique, for the most part case series involving abdominal surgery. We report 2 cases of prolonged, extensive block of thoracic and lumbar dermatomes after QL block in patients undergoing different hip surgery procedures for whom QL block was used in place of lumbar plexus block. Further prospective studies comparing these 2 techniques are necessary to better characterize the role of QL block in hip surgery.
{"title":"Quadratus Lumborum Block as an Alternative to Lumbar Plexus Block for Hip Surgery: A Report of 2 Cases.","authors":"L. La Colla, B. Ben-david, Rita B Merman","doi":"10.1213/XAA.0000000000000406","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000406","url":null,"abstract":"Quadratus lumborum (QL) block was first described several years ago, but few articles have been published regarding this technique, for the most part case series involving abdominal surgery. We report 2 cases of prolonged, extensive block of thoracic and lumbar dermatomes after QL block in patients undergoing different hip surgery procedures for whom QL block was used in place of lumbar plexus block. Further prospective studies comparing these 2 techniques are necessary to better characterize the role of QL block in hip surgery.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"124 1","pages":"4-6"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74836373","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 : 2017-01-01DOI: 10.1213/XAA.0000000000000412
Brittney Williams, M. Mazzeffi, P. Sanchez, S. Pham, Z. Kon, Kenichi A. Tanaka
Acquired antithrombin (AT) deficiency is not uncommon in cardiothoracic surgery because of heparin exposure and dilutional or consumptive losses. We report a case of acquired AT deficiency and resultant multiple deep vein thrombosis in a patient with pulmonary fibrosis on veno-venous extracorporeal membrane oxygenation who underwent double lung transplantation with intraoperative therapeutic plasma exchange (TPE) as a part of an immunomodulation regimen for allosensitization. Preoperative heparin anticoagulation resulted in AT deficiency, which was further exacerbated by TPE using albumin. The recovery of AT activity after TPE with plasma was incomplete, and postoperative deficiencies of AT and other anticoagulants might have contributed to deep vein thromboses. The limitation of thromboelastometry in detecting AT deficiency was evident.
{"title":"Case Report of Severe Antithrombin Deficiency During Extracorporeal Membrane Oxygenation and Therapeutic Plasma Exchange for Double Lung Transplantation.","authors":"Brittney Williams, M. Mazzeffi, P. Sanchez, S. Pham, Z. Kon, Kenichi A. Tanaka","doi":"10.1213/XAA.0000000000000412","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000412","url":null,"abstract":"Acquired antithrombin (AT) deficiency is not uncommon in cardiothoracic surgery because of heparin exposure and dilutional or consumptive losses. We report a case of acquired AT deficiency and resultant multiple deep vein thrombosis in a patient with pulmonary fibrosis on veno-venous extracorporeal membrane oxygenation who underwent double lung transplantation with intraoperative therapeutic plasma exchange (TPE) as a part of an immunomodulation regimen for allosensitization. Preoperative heparin anticoagulation resulted in AT deficiency, which was further exacerbated by TPE using albumin. The recovery of AT activity after TPE with plasma was incomplete, and postoperative deficiencies of AT and other anticoagulants might have contributed to deep vein thromboses. The limitation of thromboelastometry in detecting AT deficiency was evident.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"46 1","pages":"11-13"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80056370","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 : 2017-01-01DOI: 10.1213/XAA.0000000000000407
U. Williams, A. Zavala, A. Van Meter, E. Rebello, Jens Tan, P. Owusu-Agyemang
Neurofibromatosis type 1 is an autosomal-dominant disorder with the tendency toward the formation of tumors. Plexiform neurofibromas are the most common type of tumors seen in neurofibromatosis type 1. Approximately 50% occur in the head and neck region with a 5% incidence of airway involvement. We describe the case of a 5 month old with a plexiform neurofibroma of the neck who developed complete airway obstruction on induction of anesthesia. Magnetic resonance imaging revealed a skull base neurofibroma extending to the hypopharynx and resulting in deviation of the airway. Because of the possibility of airway involvement, a careful preanesthetic evaluation as well as a slow induction with the maintenance of spontaneous ventilation should be considered in patients presenting with facial neurofibromas.
{"title":"Unanticipated Compression of the Trachea in a 5-Month-Old Undergoing an MRI for Evaluation of Neurofibromatosis.","authors":"U. Williams, A. Zavala, A. Van Meter, E. Rebello, Jens Tan, P. Owusu-Agyemang","doi":"10.1213/XAA.0000000000000407","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000407","url":null,"abstract":"Neurofibromatosis type 1 is an autosomal-dominant disorder with the tendency toward the formation of tumors. Plexiform neurofibromas are the most common type of tumors seen in neurofibromatosis type 1. Approximately 50% occur in the head and neck region with a 5% incidence of airway involvement. We describe the case of a 5 month old with a plexiform neurofibroma of the neck who developed complete airway obstruction on induction of anesthesia. Magnetic resonance imaging revealed a skull base neurofibroma extending to the hypopharynx and resulting in deviation of the airway. Because of the possibility of airway involvement, a careful preanesthetic evaluation as well as a slow induction with the maintenance of spontaneous ventilation should be considered in patients presenting with facial neurofibromas.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"60 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2017-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80858111","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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