Sarah Park, Mariam Ibrahim, Augusto Torres
Midazolam is a widely used benzodiazepine due to its rapid onset of action and relatively safe side effect profile. It is used for sedation, anxiolysis, and induction of general anesthesia. However, in <1% of instances, it may cause a paradoxical excitement: agitation, restlessness, myoclonus, stiffening of the limbs, and aggression. We report a case report in which preoperative administration of midazolam caused onset of the aforementioned symptoms that were not attenuated by general anesthesia with dexmedetomidine...
2024: Case Reports in Anesthesiology
Masaaki Nakajima
Thumb carpometacarpal (CMC) arthropathy pain is treated using carbonated water-a commercially available beverage. The right hand (affected side) was bathed once daily in carbonated beverage water (37°C) for 20 min. Prior to treatment, the visual analogue scale score of pain was 73 mm; 1 week after the treatment, it was 0 mm. Commercial carbonated water immersion was effective for thumb CMC arthropathy pain. Commercial carbonated water is inexpensive and easy to obtain, making it suitable for home carbonation therapy...
2024: Case Reports in Anesthesiology
Anna Tanaka, Tim Cai, Michael Platten, Luis E Tollinche, Samuel J DeJoy
Patients with very long-chain acyl-CoA dehydrogenase deficiency (VLCADD) are prone to hypoglycemia and clinical decompensation when metabolic demands of the body are not met. We present a pediatric patient with VLCADD who underwent a posterior spinal fusion for scoliosis requiring intraoperative neurophysiology monitoring. Challenges included minimization of perioperative metabolic stressors and careful selection of anesthetic agents since propofol-based total intravenous anesthesia (TIVA) was contraindicated due to its high fatty acid content...
2024: Case Reports in Anesthesiology
Roupen Hatzakorzian, Andrea Blotsky, Albert Moore, Julien Vaillancourt, Pattra Mettasittigorn, Armen Aprikian, Steven B Backman
Approximately 4%-10% of patients with renal cell carcinoma (RCC) have tumoral vascular invasion with resultant thrombi in the renal vein and in the inferior vena cava (IVC). The authors describe an interesting case of IVC tumor thrombus that migrated to the right cardiac chambers during RCC resection. The diagnosis was made by intraoperative transesophageal echocardiography (TEE), which revealed the presence of a free-floating thrombus between the right atrium (RA) and right ventricle (RV). The patient required an urgent sternotomy with cardiopulmonary bypass (CPB) for atrial thrombus removal prior to the completion of the nephrectomy...
2023: Case Reports in Anesthesiology
Yuji Kadoi, Jo Ohta, Yumeka Sasaki, Shigeru Saito
Some controversial reports have observed oxygen desaturation (defined as percutaneous oxygen saturation (SpO2 ) < 90%) during electroconvulsive therapy (ECT). The purpose of this pilot study was to examine oxygenation states in eight patients during ECT. In addition to the usual hemodynamic monitors and pulse oximeter, the oxygen reserve index (ORi) was monitored using a pulse oximeter. Patients received either no preoxygenation or preoxygenation with 100% oxygen via a tight-fitting mask for 1 or 3 min before induction of anesthesia...
2023: Case Reports in Anesthesiology
Andrew Winegarner, Mark C Kendall, Mekhala Stephen, Afreen Siddiqui
Anaphylaxis, a type 1 hypersensitivity reaction, is a feared but uncommon complication of medications administered in the perioperative period. The incidence of perioperative hypersensitivity reactions has been reported to range from 1 in 20,000 to 1 in 1,361. Anesthesiologists are well aware of common causes of hypersensitivity such as paralytics and antibiotics; however, less common triggers of anaphylaxis need to be considered as well. Midazolam, a short acting benzodiazepine metabolized by cytochrome P450 enzymes, is considered very safe with a minimal risk profile...
2023: Case Reports in Anesthesiology
Tingting Wan, Ya Gao, Changyi Wu
Tracheal diverticulum (TD) is a rare disease. Due to the worldwide pandemic of COVID-19, the increase of routine preoperative chest CT examination has led to a higher detection rate of TD. Although TD is very rare, it is one of the reasons for difficult intubation and difficult ventilation. Improper treatment can cause severe airway emergencies such as diverticulum tearing, tracheal rupture, and subcutaneous or mediastinal emphysema. Unfortunately, there are few studies on TD, especially in perioperative airway and anesthesia management...
2023: Case Reports in Anesthesiology
Sandy Ren, Heitor Lopes, Neil Masters
Foreign body ingestion remains a common cause of pediatric emergency surgery with button battery ingestion of particular concern. Newer, higher power lithium batteries can cause catastrophic damage of the gastrointestinal tract through erosion of mucosa into surrounding structures. Prompt diagnosis and treatment are paramount. We present a case of an 11-month-old with a button battery lodged in the proximal esophagus. The extraction was difficult and only made possible with the assistance of a video laryngoscope...
2023: Case Reports in Anesthesiology
Sara Abu-Ghanem, James Cochran
BACKGROUND: Surgical fires are known, preventable, and devastating complications of transoral microlaryngeal laser surgery. Several guidelines have recommended maintaining the fraction of inspired oxygen concentration (FiO2 ) at or below 30% for open delivery cases. We hereby present our experience utilizing an air/oxygen gas mixing device (blender) attached to a supraglottic manual jet ventilator during transoral laser microlaryngeal surgery in three cases to control oxygen levels. METHODS: Retrospective chart review of three cases and literature review...
2023: Case Reports in Anesthesiology
Fiacro Jiménez-Ponce, Ylián Ramírez-Tapia, Erick Ariñez-Barahona, Jorge A Nava-López, Sai Naveen Alla
OBJECTIVE: Accidental fracture of epidural analgesia catheters has a very low incidence of 2.5 per 100,000 anesthesia. A rare image of the fracture is reported. METHODS: A 42-year-old female patient was attending a cesarean section eight years earlier to her consult. In the cesarean section, she received regional epidural anesthesia, and the main complaint was low back pain, specifically between the spinous processes L2 and L3. The somatic pain had been presenting intermittently for eight years...
2023: Case Reports in Anesthesiology
Hicham Ziani, Med Yassir Lahbabi, Nabil Elachhab, Nawfel Elcaidi, Aziz Slaoui, Hanaa Lazhar, Sophia Lahbabi, Aziz Baidada, Nezha Oudghiri, Rajae Tachinante
Lumboperitoneal shunt may be indicated as a treatment for idiopathic intracranial hypertension aiming to facilitate the dynamic flow of cerebrospinal fluid into the peritoneum for patients. Parturients with lumboperitoneal shunt are a few, making it difficult to choose the analgesic or anesthetic technique for delivery. We present the case of a successful spinal anesthesia for a cesarean delivery in a parturient who was diagnosed with idiopathic intracranial hypertension that was treated by lumboperitoneal shunt...
2023: Case Reports in Anesthesiology
Christine Ha, Rotem Naftalovich, Faraz Chaudhry, Jean Eloy, Erica Spano, George Tewfik
Obtaining vascular access through a superficial vein of the abdominal wall of a gravida patient is an option in an emergency Cesarean surgery when other means fail. Such superficial veins may be mistaken for striae gravidarum on physical exam. A small intravenous (IV) cannula is not ideal but could save valuable time and avoid delaying induction of general anesthesia. Once the airway is secured, a larger bore IV can then be inserted while surgical exposure is undergoing. Analysis of the risks and benefits of inducing general anesthesia with a small gauge IV for a gravida patient should take into consideration risk factors for massive peripartum hemorrhage such as placental disorders (accreta, increta, precreta, abruption, or previa), presence of uterine fibroids, preeclampsia, hemolysis, elevated liver enzymes, low platelet count (HELP syndrome), severe polyhydramnios, history of grand multiparty, and bleeding disorders such as Von Willibrands and hemophilia...
2023: Case Reports in Anesthesiology
Sae Nakagawa, Tomoharu Shakuo, Sakurako Matsudo, Hiroaki Soda, Kenji Shida
BACKGROUND: Critical upper airway obstruction, hematoma formation, and recurrent laryngeal nerve palsy have been reported as postoperative complications of thyroid surgery. Although remimazolam may reduce the risk of these complications, the efficacy of flumazenil with remimazolam has not been reported. We present the successful anesthesia management of thyroid surgery using remimazolam and flumazenil. Case Presentation . A 72-year-old woman was diagnosed with a goiter and scheduled for a partial thyroidectomy under general anesthesia...
2023: Case Reports in Anesthesiology
Gen Owada, Hideo Nishizawa, Yuki Matoyama, Eri Watanabe, Keigo Mitsuda, Naoki Kaneko, Yasuhiro Kimura, Taikan Nanao, Junichi Fujimoto
5-Aminolevulinic acid (5-ALA) is used for the photodynamic diagnosis of malignant tumors and has been effectively utilized to improve the complete resection rate and reduce the risk of tumor recurrence. However, intraoperative hypotension is a common adverse effect of oral 5-ALA, and it occasionally progresses to severe prolonged hypotension requiring high-dose catecholamine administration. We report a case of intraoperative hypotension due to oral 5-ALA in which arginine vasopressin (AVP) administration was effective for increasing the blood pressure...
2023: Case Reports in Anesthesiology
Sara Kianian, Giacomo Scorsese, Eric Zabirowicz, Jeremy Poppers
Hemophilia C is a rare bleeding disorder characterized by a deficiency in clotting factor XI (fXI) and has no standard of care for preoperative optimization before cardiac surgery. Normalization of fXI levels in patients with hemophilia C can be achieved with fresh frozen plasma (FFP), which sometimes results in allergic reactions. We present a case of a patient with hemophilia C requiring coronary artery bypass grafting surgery who developed an allergic reaction to FFP. Our report underscores the balance between thrombosis and bleeding risks when devising a perioperative plan for patients with hemophilia C...
2023: Case Reports in Anesthesiology
Katelyn Glines, J W Awori Hayanga, Christina Gibson, Mohamad El Churafa, Lawrence Wei, Heather K Hayanga
Systolic anterior motion (SAM) describes a pathologic condition of the mitral valve in which the anterior leaflet is displaced anteriorly, resulting in a narrowed left ventricular outflow tract (LVOT). The implications of SAM may range in severity from clinically insignificant disease to severe LVOT obstruction resulting in hemodynamic collapse. While SAM is typically observed in patients with hypertrophic cardiomyopathy or following mitral valve repair, it may be seen in any setting in which the anatomy and function of the left ventricle has been altered...
2023: Case Reports in Anesthesiology
Robert Pagan-Rosado, Brandon J Smith, Fantley C Smither, Matthew J Pingree, Ryan S D'Souza
This case series aims to highlight the efficacy of peripheral nerve stimulation (PNS) in the treatment of phantom limb pain, as well as provide an alternative method for the treatment of this pain syndrome. In this report, we describe three amputee patients with severe phantom limb pain who obtained substantial analgesia and improvement in physical functionality after implantation of a temporary PNS device. Future studies should assess predictors of successful response or poor response to PNS therapy, such as mental health, environmental stressors, coping skills, and procedural factors...
2023: Case Reports in Anesthesiology
Takashi Kawasaki, Takafumi Oyoshi, Naoyuki Hirata
BACKGROUND: Intraoperative anesthetic requirements might be altered due to the modulated metabolic function in living donor liver transplant recipients. Remimazolam may provide appropriate anesthesia in patients with cirrhosis. However, the efficacy and safety of remimazolam in liver transplant recipients have not been reported. We present the successful anesthesia management of a liver transplant recipient using remimazolam. Case Presentation . A 54-year-old woman who was diagnosed with Child-Pugh C cirrhosis of unknown etiology was scheduled for living donor liver transplantation...
2023: Case Reports in Anesthesiology
Kristina L Michaud, Robert H Thiele, Katherine T Forkin
Symptomatic carotid stenosis and pheochromocytoma both require timely surgical intervention. Following a transient ischemic attack (TIA), a 46-year-old man was diagnosed with bilateral carotid artery stenosis and scheduled for carotid endarterectomy. He was a poor candidate for minimally invasive options due to prior neck radiation. Simultaneously, he began experiencing difficulty with diabetes management and elevated blood pressures and was ultimately diagnosed with pheochromocytoma. This unique situation required coordination to determine the appropriate timing of the two interventions...
2023: Case Reports in Anesthesiology
Sung-Wook Choi, Elizabeth Putnam
A 15-year-old girl with congenital methemoglobinemia and no prior anesthetic history presented for the extraction of multiple impacted molars. Pulse oximetry values were expected to complicate the accurate monitoring of her oxygenation status in the perioperative period. An arterial line was placed for hemodynamic monitoring, arterial blood gas (ABG) analysis, and obtaining the methemoglobin (MetHgb) level and additional blood gases if clinically indicated. A continuous CO-oximeter was also used. Her intraoperative course was uneventful and she was discharged home on the same day of the procedure...
2023: Case Reports in Anesthesiology
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