A. R. Karthik, K. Murugesan, N. Srinivasaraghavan, D. Kumar
{"title":"Central venous catheter placement in a patient with persistent left superior vena cava","authors":"A. R. Karthik, K. Murugesan, N. Srinivasaraghavan, D. Kumar","doi":"10.1002/anr3.12288","DOIUrl":"https://doi.org/10.1002/anr3.12288","url":null,"abstract":"","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140139169","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}
The presentation of acute and rapidly deteriorating airway pathology can be a highly challenging situation for any hospital team. Cricoid chondromas are a challenging and potentially unfamiliar airway pathology requiring the combined expertise of anaesthetists, ear, nose and throat surgeons and a wider peri-operative team familiar with managing airway emergencies. Airway lesions which cause rigid and fixed stenosis require careful management and present additional challenges compared to soft tissue lesions. An important consideration in fixed airway stenosis is the external diameter of tracheal tubes compared to the diameter of the airway at its narrowest point. These are challenging cases to manage and a multi-disciplinary approach to the safe management of unfamiliar and critical airway pathology should be adopted.
{"title":"Management of acute airway compromise secondary to cricoid chondroma","authors":"A. Song, M. B. Shahid","doi":"10.1002/anr3.12281","DOIUrl":"https://doi.org/10.1002/anr3.12281","url":null,"abstract":"<div>\u0000 \u0000 <p>The presentation of acute and rapidly deteriorating airway pathology can be a highly challenging situation for any hospital team. Cricoid chondromas are a challenging and potentially unfamiliar airway pathology requiring the combined expertise of anaesthetists, ear, nose and throat surgeons and a wider peri-operative team familiar with managing airway emergencies. Airway lesions which cause rigid and fixed stenosis require careful management and present additional challenges compared to soft tissue lesions. An important consideration in fixed airway stenosis is the external diameter of tracheal tubes compared to the diameter of the airway at its narrowest point. These are challenging cases to manage and a multi-disciplinary approach to the safe management of unfamiliar and critical airway pathology should be adopted.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140053244","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}
A 73-year-old woman underwent an awake craniotomy for the resection of a supratentorial brain tumour. We provided sedation for the surgery using a dexmedetomidine target controlled infusion using the Dyck pharmacokinetic model. Using a target controlled infusion allowed more rapid titration to the desired plasma level compared with a manual infusion, without any unexpected cardiovascular, respiratory or other complications. Rapid titration of sedation during awake craniotomy is desirable, allowing deeper sedation during stimulating parts of the surgery, followed by lighter sedation – or absence of sedation – during cortical mapping. While this can be performed manually, we found utilising the Dyck model in this case simple and quick to use, avoiding the need to manually calculate infusion rates. We believe this is the first report of using a target controlled infusion model to administer dexmedetomidine for awake craniotomy, and suggest it could be considered as an alternative to administering a manual infusion.
{"title":"Dexmedetomidine target controlled infusion for awake craniotomy†","authors":"A. Al-Attar, M. Back, J. Sebastian","doi":"10.1002/anr3.12283","DOIUrl":"https://doi.org/10.1002/anr3.12283","url":null,"abstract":"<div>\u0000 \u0000 <p>A 73-year-old woman underwent an awake craniotomy for the resection of a supratentorial brain tumour. We provided sedation for the surgery using a dexmedetomidine target controlled infusion using the Dyck pharmacokinetic model. Using a target controlled infusion allowed more rapid titration to the desired plasma level compared with a manual infusion, without any unexpected cardiovascular, respiratory or other complications. Rapid titration of sedation during awake craniotomy is desirable, allowing deeper sedation during stimulating parts of the surgery, followed by lighter sedation – or absence of sedation – during cortical mapping. While this can be performed manually, we found utilising the Dyck model in this case simple and quick to use, avoiding the need to manually calculate infusion rates. We believe this is the first report of using a target controlled infusion model to administer dexmedetomidine for awake craniotomy, and suggest it could be considered as an alternative to administering a manual infusion.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140053245","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}
Optimal pain management after open abdominal surgery is essential but can be difficult to achieve. The effects of inadequate analgesia go beyond the first few postoperative days; severe acute postoperative pain may contribute to the development of chronic postsurgical pain. Thoracic epidural analgesia is a traditional approach to the management of acute pain after open abdominal surgery but has multiple possible contraindications and can be technically challenging. In our hospital, we typically offer ultrasound-guided rectus sheath blocks with catheters when epidural analgesia is not feasible. However, the recent registration of long-acting liposomal bupivacaine in the Netherlands as well as logistical and equipment-related issues have led us to consider liposomal bupivacaine as an alternative to the use of catheters. Here, we present a short case series to describe our first clinical experiences with the use of liposomal bupivacaine in ultrasound-guided rectus sheath blocks after midline laparotomy for three patients in whom epidural insertion was contraindicated.
{"title":"Liposomal bupivacaine for ultrasound-guided rectus sheath blocks after midline laparotomy","authors":"M. S. Vereen, F. Harms, R. J. Stolker, M. Dirckx","doi":"10.1002/anr3.12284","DOIUrl":"https://doi.org/10.1002/anr3.12284","url":null,"abstract":"<p>Optimal pain management after open abdominal surgery is essential but can be difficult to achieve. The effects of inadequate analgesia go beyond the first few postoperative days; severe acute postoperative pain may contribute to the development of chronic postsurgical pain. Thoracic epidural analgesia is a traditional approach to the management of acute pain after open abdominal surgery but has multiple possible contraindications and can be technically challenging. In our hospital, we typically offer ultrasound-guided rectus sheath blocks with catheters when epidural analgesia is not feasible. However, the recent registration of long-acting liposomal bupivacaine in the Netherlands as well as logistical and equipment-related issues have led us to consider liposomal bupivacaine as an alternative to the use of catheters. Here, we present a short case series to describe our first clinical experiences with the use of liposomal bupivacaine in ultrasound-guided rectus sheath blocks after midline laparotomy for three patients in whom epidural insertion was contraindicated.</p>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/anr3.12284","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140053246","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
F. Lovisari, T. Gonzenbach, C. Hemmaway, D. Sadani, M. Hogan
We report the case of a woman who developed post-transfusion purpura following complicated cardiac surgery requiring multiple blood product transfusions and extracorporeal life support. This case highlights the challenges of managing thrombocytopenia in patients supported with prolonged mechanical cardiovascular and renal support with ongoing blood product transfusion requirements. The differential diagnoses are broad, varied and may overlap. Whilst post-transfusion purpura is very rare, clinical signs may prompt consideration and further specific diagnostic testing. Once confirmed, management is then specific, with some aspects which are at direct variance with standard intensive care and extracorporeal life support guidelines for the management of non-specific thrombocytopenia. Consideration of the diagnosis of post-transfusion purpura early in the clinical course could help anticipate and prevent a vicious cycle of bleeding, transfusion and autoimmune-mediated platelet disruption, and may improve clinical outcomes.
{"title":"Post-transfusion purpura after cardiac surgery associated with veno-arterial extracorporeal membrane oxygenation*","authors":"F. Lovisari, T. Gonzenbach, C. Hemmaway, D. Sadani, M. Hogan","doi":"10.1002/anr3.12279","DOIUrl":"https://doi.org/10.1002/anr3.12279","url":null,"abstract":"<div>\u0000 \u0000 <p>We report the case of a woman who developed post-transfusion purpura following complicated cardiac surgery requiring multiple blood product transfusions and extracorporeal life support. This case highlights the challenges of managing thrombocytopenia in patients supported with prolonged mechanical cardiovascular and renal support with ongoing blood product transfusion requirements. The differential diagnoses are broad, varied and may overlap. Whilst post-transfusion purpura is very rare, clinical signs may prompt consideration and further specific diagnostic testing. Once confirmed, management is then specific, with some aspects which are at direct variance with standard intensive care and extracorporeal life support guidelines for the management of non-specific thrombocytopenia. Consideration of the diagnosis of post-transfusion purpura early in the clinical course could help anticipate and prevent a vicious cycle of bleeding, transfusion and autoimmune-mediated platelet disruption, and may improve clinical outcomes.</p>\u0000 </div>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139676808","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}
{"title":"Comment on ‘Potential interaction between exogenous anabolic steroids and sugammadex: failed reversal of rocuronium in a patient taking testosterone and trestolone acetate’","authors":"S. Stanley, J. Hansel","doi":"10.1002/anr3.12280","DOIUrl":"https://doi.org/10.1002/anr3.12280","url":null,"abstract":"","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139504588","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}
Coronary arteriovenous fistulas are an abnormal conduit between a coronary artery and another cardiovascular lumen, without an intervening capillary bed. The reported prevalence is 0.002–0.3%. Physiologic consequences such as congestive heart failure, coronary steal phenomenon and fistula aneurysm formation and rupture are possible. There are limited reports of symptomatic coronary arteriovenous fistulas in association with pregnancy. We describe a 19-year-old woman with symptomatic left circumflex artery to coronary sinus fistula, terminating into a large exophytic varix in the right atrium, presenting for an elective caesarean section at 37 weeks gestational age. Our anaesthetic management strategy aimed to optimise myocardial perfusion, maintain euvolemia, avoid right ventricular obstruction from exophytic varix and avoid sympathetic stimulation or sudden increases in pulmonary vascular resistance. A slowly titrated epidural was used as the primary anaesthetic. Our patient tolerated the procedure well and was discharged home on postoperative day two. Understanding of the potential physiologic consequence of coronary arteriovenous fistulas, and interaction with the physiologic changes of pregnancy and delivery, are essential for the management of these cases.
{"title":"Anaesthetic management of a parturient with an unrepaired coronary arteriovenous fistula for caesarean section","authors":"E. King, S. Al-Nahdi, N. Ludwig","doi":"10.1002/anr3.12276","DOIUrl":"https://doi.org/10.1002/anr3.12276","url":null,"abstract":"<p>Coronary arteriovenous fistulas are an abnormal conduit between a coronary artery and another cardiovascular lumen, without an intervening capillary bed. The reported prevalence is 0.002–0.3%. Physiologic consequences such as congestive heart failure, coronary steal phenomenon and fistula aneurysm formation and rupture are possible. There are limited reports of symptomatic coronary arteriovenous fistulas in association with pregnancy. We describe a 19-year-old woman with symptomatic left circumflex artery to coronary sinus fistula, terminating into a large exophytic varix in the right atrium, presenting for an elective caesarean section at 37 weeks gestational age. Our anaesthetic management strategy aimed to optimise myocardial perfusion, maintain euvolemia, avoid right ventricular obstruction from exophytic varix and avoid sympathetic stimulation or sudden increases in pulmonary vascular resistance. A slowly titrated epidural was used as the primary anaesthetic. Our patient tolerated the procedure well and was discharged home on postoperative day two. Understanding of the potential physiologic consequence of coronary arteriovenous fistulas, and interaction with the physiologic changes of pregnancy and delivery, are essential for the management of these cases.</p>","PeriodicalId":72186,"journal":{"name":"Anaesthesia reports","volume":"12 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1002/anr3.12276","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139480485","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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