Pub Date : 2021-08-07DOI: 10.26420/austinjanesthesiaandanalgesia.2021.1100
Köhne W, Elfers-Wassenhofen A, Nosch M, Groeben H
Over the last decades several indirect laryngoscopes have been developed to provide a significant better glottic view and improved the success rate in difficult intubations. Some case reports describe the use of indirect laryngoscopes for awake tracheal intubations under preserved spontaneous breathing. However, randomized clinical studies comparing indirect laryngoscopy to the standard of fiberoptic intubation under spontaneous breathing are rare. Therefore, we compared the intubation with the Airtraq® laryngoscope and the Bonfils endoscope, to the standard fiberoptic intubation in patients with an expected difficult intubation under local anesthesia and sedation. 150 patients with an expected difficult intubation were randomized to one of the three devices. All intubation attempts were performed under local anesthesia and sedation. We evaluated success rate, time for intubation and the satisfaction of anesthesiologists and patients. Fiberoptic intubation was significantly more successful (100%) than intubation with an Airtraq® laryngoscope (88%) or the Bonfils endoscope (88%). Time for intubation was quickest with the Airtraq® laryngoscope and significantly shorter than fiberoptic intubation (p=0.044). There was no difference in satisfaction of the anesthesiologists and none of the patients had a negative recall to one of the techniques. An expected difficult intubation can be managed using the Airtraq® laryngoscope or the Bonfils endoscope in 88% and shows the same satisfaction of anesthesiologists and patient. We conclude that these techniques represent an acceptable alternative for an awake tracheal intubation under sedation and preserved spontaneous breathing.
{"title":"Comparison of Airtraq® Laryngoscope, Bonfils Endoscope and Fiberoptic Bronchoscope for Awake Tracheal Intubation: A Randomized, Controlled Trial","authors":"Köhne W, Elfers-Wassenhofen A, Nosch M, Groeben H","doi":"10.26420/austinjanesthesiaandanalgesia.2021.1100","DOIUrl":"https://doi.org/10.26420/austinjanesthesiaandanalgesia.2021.1100","url":null,"abstract":"Over the last decades several indirect laryngoscopes have been developed to provide a significant better glottic view and improved the success rate in difficult intubations. Some case reports describe the use of indirect laryngoscopes for awake tracheal intubations under preserved spontaneous breathing. However, randomized clinical studies comparing indirect laryngoscopy to the standard of fiberoptic intubation under spontaneous breathing are rare. Therefore, we compared the intubation with the Airtraq® laryngoscope and the Bonfils endoscope, to the standard fiberoptic intubation in patients with an expected difficult intubation under local anesthesia and sedation. 150 patients with an expected difficult intubation were randomized to one of the three devices. All intubation attempts were performed under local anesthesia and sedation. We evaluated success rate, time for intubation and the satisfaction of anesthesiologists and patients. Fiberoptic intubation was significantly more successful (100%) than intubation with an Airtraq® laryngoscope (88%) or the Bonfils endoscope (88%). Time for intubation was quickest with the Airtraq® laryngoscope and significantly shorter than fiberoptic intubation (p=0.044). There was no difference in satisfaction of the anesthesiologists and none of the patients had a negative recall to one of the techniques. An expected difficult intubation can be managed using the Airtraq® laryngoscope or the Bonfils endoscope in 88% and shows the same satisfaction of anesthesiologists and patient. We conclude that these techniques represent an acceptable alternative for an awake tracheal intubation under sedation and preserved spontaneous breathing.","PeriodicalId":92989,"journal":{"name":"Austin journal of anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48655333","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 : 2021-05-14DOI: 10.26420/austinjanesthesiaandanalgesia.2021.1099
D’Onofrio Jd, Hoffmann Cr, Goldberg Sf
Hemophilia A in females accounts for few cases due to hemophilia A and B having X-linked recessive inheritance patterns. Hemostatic changes in pregnancy include an increase in coagulation factors and von Willebrand activity, placing hemophilia patients at an increased risk for Postpartum Hemorrhage (PPH). General recommendations include considering pharmacologic prophylaxis, including tranexamic acid and factor replacement when necessary. The ultimate goal is to prevent uncontrolled bleeding during vaginal or operative delivery. Benefits of prophylactic therapies must be weighed with relevant risk profiles of each intervention. We present a case where a parturient with hemophilia prophylactically treated with TXA and FVIII experienced a transient ischemic attack. We discuss the background information known regarding tranexamic acid and factor replacement, and the subsequent recommendations for their use in this patient population. We consider recommendations to expand the multidisciplinary team incorporated in the assessment and planning for the peripartum care of such a patient.
{"title":"Transient Ischemic Attack in a Hemophilia Patient with Severe Preeclampsia after Preoperative Administration of Tranexamic Acid and Factor VIII Replacement for Cesarean Section","authors":"D’Onofrio Jd, Hoffmann Cr, Goldberg Sf","doi":"10.26420/austinjanesthesiaandanalgesia.2021.1099","DOIUrl":"https://doi.org/10.26420/austinjanesthesiaandanalgesia.2021.1099","url":null,"abstract":"Hemophilia A in females accounts for few cases due to hemophilia A and B having X-linked recessive inheritance patterns. Hemostatic changes in pregnancy include an increase in coagulation factors and von Willebrand activity, placing hemophilia patients at an increased risk for Postpartum Hemorrhage (PPH). General recommendations include considering pharmacologic prophylaxis, including tranexamic acid and factor replacement when necessary. The ultimate goal is to prevent uncontrolled bleeding during vaginal or operative delivery. Benefits of prophylactic therapies must be weighed with relevant risk profiles of each intervention. We present a case where a parturient with hemophilia prophylactically treated with TXA and FVIII experienced a transient ischemic attack. We discuss the background information known regarding tranexamic acid and factor replacement, and the subsequent recommendations for their use in this patient population. We consider recommendations to expand the multidisciplinary team incorporated in the assessment and planning for the peripartum care of such a patient.","PeriodicalId":92989,"journal":{"name":"Austin journal of anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45740274","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 : 2021-03-25DOI: 10.26420/AUSTINJANESTHESIAANDANALGESIA.2021.1098
Bazin Je
Background: The aim of this study was to observe dynamic pressure and flow measurements during the breathing cycle with different concentrations of xenon in patients without pulmonary disease to provide a better understanding of the mechanical-physiological effects of gas mixtures for anesthesia and other potential applications. Ventilation and respiratory data monitoring of flow rate, pressure at the Y-piece of the ventilator circuit, inhaled volume, and concentration of oxygen, xenon, and carbon dioxide for three concentrations of xenon (0, 30, and 60%) were recorded on the anesthetic ventilator station and downloaded to a portable computer. Main Findings: The overall effects of gas concentration are compared in the superimposed flow and pressure curves recorded from the ventilator. Airway resistance increases with xenon concentration for both inspiration (p=0.0028) and expiration (p=0.0007) as expected. The compliance increased with increasing xenon concentration, but only to statistical significance between 100% oxygen and 60% xenon (p=0.0344). The percentage of pressure drop due to the breathing circuit were about 70% for all the groups (no differences statistically, p=0.8161). Conclusions: The results show that the dominant source of the pressure loss is from the breathing circuit compared to the respiratory tract in patients without respiratory disease during inspiration.
{"title":"Observational Study of Dynamic Ventilation Parameters during Xenon Anesthesia","authors":"Bazin Je","doi":"10.26420/AUSTINJANESTHESIAANDANALGESIA.2021.1098","DOIUrl":"https://doi.org/10.26420/AUSTINJANESTHESIAANDANALGESIA.2021.1098","url":null,"abstract":"Background: The aim of this study was to observe dynamic pressure and flow measurements during the breathing cycle with different concentrations of xenon in patients without pulmonary disease to provide a better understanding of the mechanical-physiological effects of gas mixtures for anesthesia and other potential applications. Ventilation and respiratory data monitoring of flow rate, pressure at the Y-piece of the ventilator circuit, inhaled volume, and concentration of oxygen, xenon, and carbon dioxide for three concentrations of xenon (0, 30, and 60%) were recorded on the anesthetic ventilator station and downloaded to a portable computer. Main Findings: The overall effects of gas concentration are compared in the superimposed flow and pressure curves recorded from the ventilator. Airway resistance increases with xenon concentration for both inspiration (p=0.0028) and expiration (p=0.0007) as expected. The compliance increased with increasing xenon concentration, but only to statistical significance between 100% oxygen and 60% xenon (p=0.0344). The percentage of pressure drop due to the breathing circuit were about 70% for all the groups (no differences statistically, p=0.8161). Conclusions: The results show that the dominant source of the pressure loss is from the breathing circuit compared to the respiratory tract in patients without respiratory disease during inspiration.","PeriodicalId":92989,"journal":{"name":"Austin journal of anesthesia and analgesia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-03-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41509845","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 : 2021-02-09DOI: 10.26420/AUSTINJANESTHESIAANDANALGESIA.2021.1096
Erdost Ha, Ozbilgin S, Kuvaki B
In general, COVID-19 is an acute disease, and the most common symptoms at onset are fever, dry cough, and fatigue, partly with nausea, diarrhea, or other gastrointestinal symptoms [1,2]. Also it has association with neurological symptoms, cardiovascular involvement, and hypercoagulability [3-13]. Anesthesiologists are confronted with these patients not only in intensive care but also in the operating room. In this brief review we focused on what do we know about COVID-19, and how to manage anesthesia and operating room when surgery is needed under the light of our experience and expertise in the field.
{"title":"What do we know about SARS-Cov-2 and Anesthesia Management?","authors":"Erdost Ha, Ozbilgin S, Kuvaki B","doi":"10.26420/AUSTINJANESTHESIAANDANALGESIA.2021.1096","DOIUrl":"https://doi.org/10.26420/AUSTINJANESTHESIAANDANALGESIA.2021.1096","url":null,"abstract":"In general, COVID-19 is an acute disease, and the most common symptoms at onset are fever, dry cough, and fatigue, partly with nausea, diarrhea, or other gastrointestinal symptoms [1,2]. Also it has association with neurological symptoms, cardiovascular involvement, and hypercoagulability [3-13]. Anesthesiologists are confronted with these patients not only in intensive care but also in the operating room. In this brief review we focused on what do we know about COVID-19, and how to manage anesthesia and operating room when surgery is needed under the light of our experience and expertise in the field.","PeriodicalId":92989,"journal":{"name":"Austin journal of anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46719386","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 : 2021-01-28DOI: 10.26420/AUSTINJANESTHESIAANDANALGESIA.2021.1095
Kreijveld Bj, Bekkers Ipw, E. Mulder, Wassen Mmlh
Background: Lack of postoperative acute pain management is associated with increased morbidity, longer recovery time, more opioid use and subsequently increased health care costs. There is increasing evidence that Virtual Reality (VR) is effective in the reduction of acute pain. Alternative methods to reduce postoperative pain and multimodal analgesia are necessary for acute postoperative pain management and to reduce opioid use and their adverse effects. The aim of this study is to explore the effect of VR on pain in the postoperative period after elective gynecological surgery. Methods and Design: The study concerns a non-blinded, single center, randomized controlled trial. Eligible women fulfilling the inclusion criteria and receive elective gynecological surgery in the Zuyderland Medical Center will be randomized for participation. The study population will be randomly divided into the intervention group (VR-group) or the standard care- group. The intervention group can choose for an immersive guided relaxation VR experience or an interactive VR experience during the pre- and postoperative period additional to the usual standard care. The participants randomized to the standard caregroup will receive only the usual standard care pre-and postoperative. The primary outcome is postoperative pain measured on a Numeric Rating Scale (NRS). A total of 30 patients have to be included in each group. This means that a total of 60 women will have to be included in this study. Secondary outcomes are; evaluating pre-and postoperative anxiety, pain catastrophizing, analgesic use, length of hospital stay between both groups and to explore tolerability, feasibility and satisfaction of VR use. Discussion: This study will provide insight as to whether in women who receive gynecological surgery, VR is an effective method to reduce postoperative pain and subsequently opioid use.
{"title":"The Effect of Virtual Reality on Anxiety and Pain in Patients Undergoing Gynecological Surgery (VRAP-G); a Randomized Controlled Trial","authors":"Kreijveld Bj, Bekkers Ipw, E. Mulder, Wassen Mmlh","doi":"10.26420/AUSTINJANESTHESIAANDANALGESIA.2021.1095","DOIUrl":"https://doi.org/10.26420/AUSTINJANESTHESIAANDANALGESIA.2021.1095","url":null,"abstract":"Background: Lack of postoperative acute pain management is associated with increased morbidity, longer recovery time, more opioid use and subsequently increased health care costs. There is increasing evidence that Virtual Reality (VR) is effective in the reduction of acute pain. Alternative methods to reduce postoperative pain and multimodal analgesia are necessary for acute postoperative pain management and to reduce opioid use and their adverse effects. The aim of this study is to explore the effect of VR on pain in the postoperative period after elective gynecological surgery. Methods and Design: The study concerns a non-blinded, single center, randomized controlled trial. Eligible women fulfilling the inclusion criteria and receive elective gynecological surgery in the Zuyderland Medical Center will be randomized for participation. The study population will be randomly divided into the intervention group (VR-group) or the standard care- group. The intervention group can choose for an immersive guided relaxation VR experience or an interactive VR experience during the pre- and postoperative period additional to the usual standard care. The participants randomized to the standard caregroup will receive only the usual standard care pre-and postoperative. The primary outcome is postoperative pain measured on a Numeric Rating Scale (NRS). A total of 30 patients have to be included in each group. This means that a total of 60 women will have to be included in this study. Secondary outcomes are; evaluating pre-and postoperative anxiety, pain catastrophizing, analgesic use, length of hospital stay between both groups and to explore tolerability, feasibility and satisfaction of VR use. Discussion: This study will provide insight as to whether in women who receive gynecological surgery, VR is an effective method to reduce postoperative pain and subsequently opioid use.","PeriodicalId":92989,"journal":{"name":"Austin journal of anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47252445","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 : 2021-01-19DOI: 10.26420/AUSTINJANESTHESIAANDANALGESIA.2021.1094
S. Ahmad, M. Sabia
Background: Complex Regional Pain Syndrome (CRPS) is a neuropathic pain syndrome associated with edema, muscle weakness, and hyperhidrosis. It can be precipitated by fracture, surgery, and spinal cord injury and usually involves the ipsilateral and sometimes contralateral extremity. Case Details: A 47-year-old male with CRPS Type-II involving the upper extremity had severe neuropathic pain that was limiting his ADLs despite medical, physical and occupational therapy. This case discusses the use of stellate ganglion block in the treatment of upper extremity CRPS Type-II. Conclusion: Stellate ganglion blockade is an effective adjuvant therapy in the treatment of CRPS Type-II when conservative therapy has failed to provide improvement in pain, highlighting a need for a multimodal therapeutic strategy. Keywords: Stellate ganglion block; Chronic pain; Complex regional pain syndrome type-II; Bupivacaine
{"title":"Use of Stellate Ganglion Local Anesthetic Blockade for Treatment of Complex Regional Pain Syndrome Type-II of the Upper Extremity: A Case Report of One Patient’s Experience after Traumatic Hand Injury","authors":"S. Ahmad, M. Sabia","doi":"10.26420/AUSTINJANESTHESIAANDANALGESIA.2021.1094","DOIUrl":"https://doi.org/10.26420/AUSTINJANESTHESIAANDANALGESIA.2021.1094","url":null,"abstract":"Background: Complex Regional Pain Syndrome (CRPS) is a neuropathic pain syndrome associated with edema, muscle weakness, and hyperhidrosis. It can be precipitated by fracture, surgery, and spinal cord injury and usually involves the ipsilateral and sometimes contralateral extremity. Case Details: A 47-year-old male with CRPS Type-II involving the upper extremity had severe neuropathic pain that was limiting his ADLs despite medical, physical and occupational therapy. This case discusses the use of stellate ganglion block in the treatment of upper extremity CRPS Type-II. Conclusion: Stellate ganglion blockade is an effective adjuvant therapy in the treatment of CRPS Type-II when conservative therapy has failed to provide improvement in pain, highlighting a need for a multimodal therapeutic strategy. Keywords: Stellate ganglion block; Chronic pain; Complex regional pain syndrome type-II; Bupivacaine","PeriodicalId":92989,"journal":{"name":"Austin journal of anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2021-01-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46609140","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 : 2019-02-01DOI: 10.26420/AUSTINJANESTHESIAANDANALGESIA.2019.1076
preechakul P
We describe a patient with persistent central neuropathic pain caused by intramedullary hemorrhage from spinal dural arteriovenous fistula (SDAVF). A 34-year-old woman suffered from sudden severe electric-like pain and paresthesia at the left anterior and posterior chest wall below nipple line, corresponding with T6 dermatome, without muscle weakness or bowel/ bladder dysfunction involving. Magnetic resonance imaging (MRI) revealed intramedullary hemorrhage extending from the level of lower T5 to upper T7 of the left side of the spinal cord with abnormal intradural flow voids along left posterolateral cord surface from the level of T6 to T11. Spinal angiography demonstrated SDAVF, fed by radiculomeningeal branches from the left T5 and T6 intercostal arteries with drainage into ascending and descending prominent and tortuous perimedullary draining veins. There was a venous varix, probably causing hematomyelia. The left T6 intercostal artery not only gave rise the branch to the fistula, but also anterior spinal artery. Therefore, endovascular treatment with liquid embolic material was contraindication for this patient. Due to intractable at-level neuropathic pain, she underwent thoracic laminectomy with microsurgical obliteration of the fistula and dorsal root entry zone lesioning in the same session. The previous chest pain preoperatively was totally relieved for a few days after surgery. Unfortunately, the neuropathic pain gradually returned with stabbing, cramping, and itching sensation. The pain-aggravating factors were premenstrual period, stress, mechanical pressure, and fear of untreatable pain. The pain- relieving factors were warm bath and gentle rub. Intractable neuropathic pain was treated with multi-drug therapy, including opioid, tricyclic antidepressant, and antiepileptic drugs. At 2 years after operation, the pain was controlled in acceptable level with pain score of 2/10. Follow-up spinal angiography and MRI confirmed complete obliteration of the fistula and disappearance of blood components in spinal cord without spinal cord atrophy. From the literature, the authors found another 5 patients suffering from intramedullary hemorrhage caused by SDAVFs. However, there was no persistent neuropathic pain in these patients similar to the present study.
{"title":"Persistent Central Neuropathic Pain Caused by Intramedullary Hemorrhage from Spinal Dural Arteriovenous Fistula: A Case Report and Literature Review","authors":"preechakul P","doi":"10.26420/AUSTINJANESTHESIAANDANALGESIA.2019.1076","DOIUrl":"https://doi.org/10.26420/AUSTINJANESTHESIAANDANALGESIA.2019.1076","url":null,"abstract":"We describe a patient with persistent central neuropathic pain caused by intramedullary hemorrhage from spinal dural arteriovenous fistula (SDAVF). A 34-year-old woman suffered from sudden severe electric-like pain and paresthesia at the left anterior and posterior chest wall below nipple line, corresponding with T6 dermatome, without muscle weakness or bowel/ bladder dysfunction involving. Magnetic resonance imaging (MRI) revealed intramedullary hemorrhage extending from the level of lower T5 to upper T7 of the left side of the spinal cord with abnormal intradural flow voids along left posterolateral cord surface from the level of T6 to T11. Spinal angiography demonstrated SDAVF, fed by radiculomeningeal branches from the left T5 and T6 intercostal arteries with drainage into ascending and descending prominent and tortuous perimedullary draining veins. There was a venous varix, probably causing hematomyelia. The left T6 intercostal artery not only gave rise the branch to the fistula, but also anterior spinal artery. Therefore, endovascular treatment with liquid embolic material was contraindication for this patient. Due to intractable at-level neuropathic pain, she underwent thoracic laminectomy with microsurgical obliteration of the fistula and dorsal root entry zone lesioning in the same session. The previous chest pain preoperatively was totally relieved for a few days after surgery. Unfortunately, the neuropathic pain gradually returned with stabbing, cramping, and itching sensation. The pain-aggravating factors were premenstrual period, stress, mechanical pressure, and fear of untreatable pain. The pain- relieving factors were warm bath and gentle rub. Intractable neuropathic pain was treated with multi-drug therapy, including opioid, tricyclic antidepressant, and antiepileptic drugs. At 2 years after operation, the pain was controlled in acceptable level with pain score of 2/10. Follow-up spinal angiography and MRI confirmed complete obliteration of the fistula and disappearance of blood components in spinal cord without spinal cord atrophy. From the literature, the authors found another 5 patients suffering from intramedullary hemorrhage caused by SDAVFs. However, there was no persistent neuropathic pain in these patients similar to the present study.","PeriodicalId":92989,"journal":{"name":"Austin journal of anesthesia and analgesia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47765254","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 : 2018-12-18DOI: 10.26420/AUSTINJANESTHESIAANDANALGESIA.2018.1075
Cortés-Lares Ja
The inability to successfully manage a difficult airway is responsible for 600 annual deaths, 30% of which are attributable to anesthesia [1]. According to Gil, et al., 18% of patients are difficult to intubate, 5% are difficult to oxygenate and between 0.004 and 0.008% cannot be intubated or oxygenated [2]. Treating patients with genetic abnormalities is a challenge. Turner syndrome is a disease that has a prevalence of 2000 to 2500 alive, female children [3]. It is a result of partial or complete X chromosome monosomy [4]. It is not odd these patients need surgery for other causes from their genetic pathology. The present case emphasizes on the increasing difficulty of airway management on patients with Turner syndrome and the use of videolaringoscope and tube introducer [5].
{"title":"Successful Management of Difficult Airway in an Adult Patient of Turner Syndrome","authors":"Cortés-Lares Ja","doi":"10.26420/AUSTINJANESTHESIAANDANALGESIA.2018.1075","DOIUrl":"https://doi.org/10.26420/AUSTINJANESTHESIAANDANALGESIA.2018.1075","url":null,"abstract":"The inability to successfully manage a difficult airway is responsible for 600 annual deaths, 30% of which are attributable to anesthesia [1]. According to Gil, et al., 18% of patients are difficult to intubate, 5% are difficult to oxygenate and between 0.004 and 0.008% cannot be intubated or oxygenated [2]. Treating patients with genetic abnormalities is a challenge. Turner syndrome is a disease that has a prevalence of 2000 to 2500 alive, female children [3]. It is a result of partial or complete X chromosome monosomy [4]. It is not odd these patients need surgery for other causes from their genetic pathology. The present case emphasizes on the increasing difficulty of airway management on patients with Turner syndrome and the use of videolaringoscope and tube introducer [5].","PeriodicalId":92989,"journal":{"name":"Austin journal of anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-12-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46041616","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 : 2018-07-26DOI: 10.26420/austinjanesthesiaandanalgesia.2018.1072
Rajesh Kasimahanti
She underwent uneventful coronary artery bypass grafting with 3 appropriate grafts. Early postoperative course was uneventful, started on antiplatelets, anticoagulants, statins, and supportive care and shifted out of ICU on POD2. On 5 th postoperative day, she developed sudden onset right hemiparesis, deviation of mouth to left and drowsiness. On physical examination, patient had profound right-sided neglect and conjugate deviation of the eyes to the left side. Motor examination showed grade 0 power on right upper and lower extremities, 3+ reflexes on the right and 2+ reflexes on the left with positive babinski on the right side. She was intubated, shifted to emergency CT brain to rule out acute cerebro vascular accident. CT showed a linear hyperdense structure extending from left ICA bifurcation into left sylvian fissure, suggestive of hyperdense left MCA (HU 69) could be secondary to acute thrombus. Rest of brain in and territory of with
{"title":"Hyperdense MCA Sign","authors":"Rajesh Kasimahanti","doi":"10.26420/austinjanesthesiaandanalgesia.2018.1072","DOIUrl":"https://doi.org/10.26420/austinjanesthesiaandanalgesia.2018.1072","url":null,"abstract":"She underwent uneventful coronary artery bypass grafting with 3 appropriate grafts. Early postoperative course was uneventful, started on antiplatelets, anticoagulants, statins, and supportive care and shifted out of ICU on POD2. On 5 th postoperative day, she developed sudden onset right hemiparesis, deviation of mouth to left and drowsiness. On physical examination, patient had profound right-sided neglect and conjugate deviation of the eyes to the left side. Motor examination showed grade 0 power on right upper and lower extremities, 3+ reflexes on the right and 2+ reflexes on the left with positive babinski on the right side. She was intubated, shifted to emergency CT brain to rule out acute cerebro vascular accident. CT showed a linear hyperdense structure extending from left ICA bifurcation into left sylvian fissure, suggestive of hyperdense left MCA (HU 69) could be secondary to acute thrombus. Rest of brain in and territory of with","PeriodicalId":92989,"journal":{"name":"Austin journal of anesthesia and analgesia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48883992","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 : 2018-05-29DOI: 10.26420/AUSTINJANESTHESIAANDANALGESIA.2018.1070
Amr M Hilal Abdou
{"title":"Pulmonary Artery Sling: Anesthetic Challenges and Fast Track Technique","authors":"Amr M Hilal Abdou","doi":"10.26420/AUSTINJANESTHESIAANDANALGESIA.2018.1070","DOIUrl":"https://doi.org/10.26420/AUSTINJANESTHESIAANDANALGESIA.2018.1070","url":null,"abstract":"","PeriodicalId":92989,"journal":{"name":"Austin journal of anesthesia and analgesia","volume":"1 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2018-05-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42738261","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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