Pub Date : 2016-05-15DOI: 10.1213/XAA.0000000000000300
Danton Char, V. Yarlagadda, K. Maeda, Glyn Williams
Pediatric patients with end-stage respiratory failure and pulmonary hypertension traditionally have poor outcomes when bridged with extracorporeal membrane oxygenation to lung or heart-lung transplantation. Therefore, several institutions have attempted paracorporeal lung assist devices as a bridge. However, given the small number of patients, little is known about approaches to anesthetic induction in these hemodynamically unstable patients either before placement of a device or anesthetic induction once a device is in situ. In this case report, we describe our anesthetic experience managing a 13-year-old boy for both paracorporeal lung assist device placement and subsequent heart-lung transplantation.
{"title":"Anesthesia for Placement of a Paracorporeal Lung Assist Device and Subsequent Heart-Lung Transplantation in a Child with Suprasystemic Pulmonary Hypertension and End-Stage Respiratory Failure.","authors":"Danton Char, V. Yarlagadda, K. Maeda, Glyn Williams","doi":"10.1213/XAA.0000000000000300","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000300","url":null,"abstract":"Pediatric patients with end-stage respiratory failure and pulmonary hypertension traditionally have poor outcomes when bridged with extracorporeal membrane oxygenation to lung or heart-lung transplantation. Therefore, several institutions have attempted paracorporeal lung assist devices as a bridge. However, given the small number of patients, little is known about approaches to anesthetic induction in these hemodynamically unstable patients either before placement of a device or anesthetic induction once a device is in situ. In this case report, we describe our anesthetic experience managing a 13-year-old boy for both paracorporeal lung assist device placement and subsequent heart-lung transplantation.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"19 1","pages":"308-10"},"PeriodicalIF":0.0,"publicationDate":"2016-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80195141","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 : 2016-05-15DOI: 10.1213/XAA.0000000000000299
V. Saites, K. Laudanski
The hemodynamic effects of small-volume boluses of hyperosmotic solutions are often deemed negligible in the clinical setting. However, animal studies have reported decreases in systemic arterial blood pressure and bradycardia with the administration of hyperosmotic solutions. This is a report of a 60-year-old woman, intubated and sedated, who developed acute decreases in systemic arterial blood pressure with the administration of ≤50 mL of 50% dextrose. Animal studies suggest that hyperosmolar-induced hypotension may be avoided by administering the hyperosmotic solution slowly. This allows for admixture and therefore a decreased osmotic load at the proposed osmoreceptor involved in the neural reflex.
{"title":"Acute Hypotension After 50% Dextrose Injections.","authors":"V. Saites, K. Laudanski","doi":"10.1213/XAA.0000000000000299","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000299","url":null,"abstract":"The hemodynamic effects of small-volume boluses of hyperosmotic solutions are often deemed negligible in the clinical setting. However, animal studies have reported decreases in systemic arterial blood pressure and bradycardia with the administration of hyperosmotic solutions. This is a report of a 60-year-old woman, intubated and sedated, who developed acute decreases in systemic arterial blood pressure with the administration of ≤50 mL of 50% dextrose. Animal studies suggest that hyperosmolar-induced hypotension may be avoided by administering the hyperosmotic solution slowly. This allows for admixture and therefore a decreased osmotic load at the proposed osmoreceptor involved in the neural reflex.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"49 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72815330","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 : 2016-05-15DOI: 10.1213/XAA.0000000000000294
Justin S. Liberman, Wade A Weigel, J. Neal
The inability to ventilate a patient after successful intubation is a rare but emergent situation and may be caused by obstruction of the endotracheal tube, bilateral tension pneumothorax, esophageal intubation, severe bronchospasm, or mainstem bronchus intubation. We describe an increase in mean airway pressure, inability to ventilate, and loss of cardiac output secondary to a blood clot acting as a ball valve at the end of an endotracheal tube.
{"title":"Difficult Ventilation After Successful Intubation in the Emergency Setting due to a Ball Valve Clot.","authors":"Justin S. Liberman, Wade A Weigel, J. Neal","doi":"10.1213/XAA.0000000000000294","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000294","url":null,"abstract":"The inability to ventilate a patient after successful intubation is a rare but emergent situation and may be caused by obstruction of the endotracheal tube, bilateral tension pneumothorax, esophageal intubation, severe bronchospasm, or mainstem bronchus intubation. We describe an increase in mean airway pressure, inability to ventilate, and loss of cardiac output secondary to a blood clot acting as a ball valve at the end of an endotracheal tube.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"9 1","pages":"291-2"},"PeriodicalIF":0.0,"publicationDate":"2016-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75916510","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 : 2016-05-15DOI: 10.1213/XAA.0000000000000288
C. W. Connor, Michael Herzig
We describe a novel location and timekeeping system for a large, multifacility practice group using an app installed on mobile devices belonging to the staff. The system can be used independently of physical time clocks and without extracting information from anesthesia information management systems. The app creates geofences, reporting automatically when the user enters or departs the vicinity of a facility. The app displays the location of staff at all facilities, providing situational awareness. The leaving order of staff was adjusted daily using app data for the previous workload. This was successful; overtime was more evenly distributed year on year. Acceptance of the system was excellent.
{"title":"Monitoring the Location of Staff via Mobile Devices in a Large Multifacility Practice Group.","authors":"C. W. Connor, Michael Herzig","doi":"10.1213/XAA.0000000000000288","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000288","url":null,"abstract":"We describe a novel location and timekeeping system for a large, multifacility practice group using an app installed on mobile devices belonging to the staff. The system can be used independently of physical time clocks and without extracting information from anesthesia information management systems. The app creates geofences, reporting automatically when the user enters or departs the vicinity of a facility. The app displays the location of staff at all facilities, providing situational awareness. The leaving order of staff was adjusted daily using app data for the previous workload. This was successful; overtime was more evenly distributed year on year. Acceptance of the system was excellent.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"2019 1","pages":"320-8"},"PeriodicalIF":0.0,"publicationDate":"2016-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73581919","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 : 2016-05-01DOI: 10.1213/XAA.0000000000000292
L. Weinstock, Trisha L Myers, A. Walters, Oscar A Schwartz, J. Younger, P. Chopra, A. Guarino
Complex regional pain syndrome (CRPS) is evoked by conditions that may be associated with local and/or systemic inflammation. We present a case of long-standing CRPS in a patient with Ehlers-Danlos syndrome in which prolonged remission was attained by directing therapy toward concomitant small intestinal bacterial overgrowth, obstructive sleep apnea, and potential increased microglia activity. We theorize that cytokine production produced by small intestinal bacterial overgrowth and obstructive sleep apnea may act as stimuli for ongoing CRPS symptoms. CRPS may also benefit from the properties of low-dose naltrexone that blocks microglia Toll-like receptors and induces production of endorphins that regulate and reduce inflammation.
{"title":"Identification and Treatment of New Inflammatory Triggers for Complex Regional Pain Syndrome: Small Intestinal Bacterial Overgrowth and Obstructive Sleep Apnea.","authors":"L. Weinstock, Trisha L Myers, A. Walters, Oscar A Schwartz, J. Younger, P. Chopra, A. Guarino","doi":"10.1213/XAA.0000000000000292","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000292","url":null,"abstract":"Complex regional pain syndrome (CRPS) is evoked by conditions that may be associated with local and/or systemic inflammation. We present a case of long-standing CRPS in a patient with Ehlers-Danlos syndrome in which prolonged remission was attained by directing therapy toward concomitant small intestinal bacterial overgrowth, obstructive sleep apnea, and potential increased microglia activity. We theorize that cytokine production produced by small intestinal bacterial overgrowth and obstructive sleep apnea may act as stimuli for ongoing CRPS symptoms. CRPS may also benefit from the properties of low-dose naltrexone that blocks microglia Toll-like receptors and induces production of endorphins that regulate and reduce inflammation.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"6 1","pages":"272-6"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84242222","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 : 2016-05-01DOI: 10.1213/XAA.0000000000000296
A. Suchar, A. Bailey, V. Kopp
In the pediatric population, development of an abscess after epidural analgesia is a rare event. We report who is believed to be the youngest patient with development of an epidural abscess secondary to epidural catheter placement. We detail the infant's symptoms, radiographic workup, surgical treatment, and follow-up.
{"title":"Postoperative Epidural Abscess in an Infant.","authors":"A. Suchar, A. Bailey, V. Kopp","doi":"10.1213/XAA.0000000000000296","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000296","url":null,"abstract":"In the pediatric population, development of an abscess after epidural analgesia is a rare event. We report who is believed to be the youngest patient with development of an epidural abscess secondary to epidural catheter placement. We detail the infant's symptoms, radiographic workup, surgical treatment, and follow-up.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"41 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78813223","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 : 2016-05-01DOI: 10.1213/XAA.0000000000000253
R. Epstein, P. S. Jacques, J. Wanderer, Mark R Bombulie, N. Agarwalla
We studied prophylactic antibiotics administered at 2 academic medical centers during a 6-year period where a cephalosporin was indicated but an "allergy" to penicillin was noted. Another drug (typically vancomycin or clindamycin) was substituted approximately 80% of the time; this occurred frequently even when symptoms unrelated to acute hypersensitivity were listed. In >50% of cases, the reaction was either omitted or vague (e.g., simply "rash"). Given the estimated 1% cross-reactivity between penicillins and cephalosporins with similar R1 side chains, many of these patients could have received either the prescribed cephalosporin or another cephalosporin with a different R1 side chain.
{"title":"Prophylactic Antibiotic Management of Surgical Patients Noted as \"Allergic\" to Penicillin at Two Academic Hospitals.","authors":"R. Epstein, P. S. Jacques, J. Wanderer, Mark R Bombulie, N. Agarwalla","doi":"10.1213/XAA.0000000000000253","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000253","url":null,"abstract":"We studied prophylactic antibiotics administered at 2 academic medical centers during a 6-year period where a cephalosporin was indicated but an \"allergy\" to penicillin was noted. Another drug (typically vancomycin or clindamycin) was substituted approximately 80% of the time; this occurred frequently even when symptoms unrelated to acute hypersensitivity were listed. In >50% of cases, the reaction was either omitted or vague (e.g., simply \"rash\"). Given the estimated 1% cross-reactivity between penicillins and cephalosporins with similar R1 side chains, many of these patients could have received either the prescribed cephalosporin or another cephalosporin with a different R1 side chain.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"11 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90077798","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 : 2016-05-01DOI: 10.1213/XAA.0000000000000306
Christine L. Joyce, B. Greenwald, Peggy Han
Fixed and dilated pupils are disturbing when encountered during a physical examination in the pediatric intensive care unit, particularly when sedation or neuromuscular blockade confounds the neurologic examination. Rocuronium, a nondepolarizing neuromuscular drug, does not cross the blood-brain barrier and is not considered a causative agent for fixed mydriasis. We report a case of bilateral fixed and dilated pupils in a 1-week-old low-birth-weight neonate, which we contend was secondary to centrally mediated neuromuscular blockade.
{"title":"Bilateral Dilated Nonreactive Pupils in a Neonate After Surgery.","authors":"Christine L. Joyce, B. Greenwald, Peggy Han","doi":"10.1213/XAA.0000000000000306","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000306","url":null,"abstract":"Fixed and dilated pupils are disturbing when encountered during a physical examination in the pediatric intensive care unit, particularly when sedation or neuromuscular blockade confounds the neurologic examination. Rocuronium, a nondepolarizing neuromuscular drug, does not cross the blood-brain barrier and is not considered a causative agent for fixed mydriasis. We report a case of bilateral fixed and dilated pupils in a 1-week-old low-birth-weight neonate, which we contend was secondary to centrally mediated neuromuscular blockade.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"85 1","pages":"286-7"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82872794","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 : 2016-05-01DOI: 10.1213/XAA.0000000000000297
R. Khemka, A. Chakraborty, R. Ahmed, Taniya Datta, S. Agarwal
Pecs block and its variations have been used for various breast surgeries. We describe 2 cases of mastectomy and breast reconstruction by latissimus dorsi (LD) flap where regional analgesia was provided by a combination of ultrasound-guided Pecs-I block and serratus anterior plane block, a recently described technique in which local anesthetic is deposited in the plane between the LD and serratus anterior muscle. This resulted in excellent intraoperative and postoperative analgesia and a minimum of systemic analgesics. The described technique is safe to administer and provides good analgesia for breast reconstruction surgery by LD flap.
{"title":"Ultrasound-Guided Serratus Anterior Plane Block in Breast Reconstruction Surgery.","authors":"R. Khemka, A. Chakraborty, R. Ahmed, Taniya Datta, S. Agarwal","doi":"10.1213/XAA.0000000000000297","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000297","url":null,"abstract":"Pecs block and its variations have been used for various breast surgeries. We describe 2 cases of mastectomy and breast reconstruction by latissimus dorsi (LD) flap where regional analgesia was provided by a combination of ultrasound-guided Pecs-I block and serratus anterior plane block, a recently described technique in which local anesthetic is deposited in the plane between the LD and serratus anterior muscle. This resulted in excellent intraoperative and postoperative analgesia and a minimum of systemic analgesics. The described technique is safe to administer and provides good analgesia for breast reconstruction surgery by LD flap.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"56 1","pages":"280-2"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88274312","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 : 2016-05-01DOI: 10.1213/XAA.0000000000000278
Jan Hirsch, J. Generoso, R. Latoures, Y. Acar, R. Fidler
Thoracic anesthesia procedures are challenging to master during anesthesia training. A Laerdal ALS Simulator® manikin was modified by adding a bronchial tree module to create fidelity to the fourth generation. After modification, placement of endotracheal tubes up to 8.0 mm is possible by direct laryngoscopy, video laryngoscopy, and fiberoptically; in addition, it allows fiberoptically guided insertion of endobronchial blockers. Insertion of left and right 35-Fr double-lumen tubes permits double- and single-lung ventilation with continuous positive airway pressure and positive end-expiratory pressure. This anatomical modification created a high-fidelity training tool for thoracic anesthesia that has been incorporated into educational curricula for anesthesia.
{"title":"Simulation Manikin Modifications for High-Fidelity Training of Advanced Airway Procedures.","authors":"Jan Hirsch, J. Generoso, R. Latoures, Y. Acar, R. Fidler","doi":"10.1213/XAA.0000000000000278","DOIUrl":"https://doi.org/10.1213/XAA.0000000000000278","url":null,"abstract":"Thoracic anesthesia procedures are challenging to master during anesthesia training. A Laerdal ALS Simulator® manikin was modified by adding a bronchial tree module to create fidelity to the fourth generation. After modification, placement of endotracheal tubes up to 8.0 mm is possible by direct laryngoscopy, video laryngoscopy, and fiberoptically; in addition, it allows fiberoptically guided insertion of endobronchial blockers. Insertion of left and right 35-Fr double-lumen tubes permits double- and single-lung ventilation with continuous positive airway pressure and positive end-expiratory pressure. This anatomical modification created a high-fidelity training tool for thoracic anesthesia that has been incorporated into educational curricula for anesthesia.","PeriodicalId":6824,"journal":{"name":"A&A Case Reports ","volume":"1 1","pages":"268-71"},"PeriodicalIF":0.0,"publicationDate":"2016-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"91238377","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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