A&A Practice

Burbridge, Mark A.; Jaffe, Richard A.

doi: 10.1213/XAA.0000000000001148pmid: 31770135

We present the case of a 42-year-old man with moyamoya disease presenting for cerebral revascularization surgery who developed critical hyperkalemia following a single intravenous (iv) dose of 1000 mg of acetazolamide 1 day preoperatively for a cerebrovascular reactivity study. His potassium increased from 5.1 to 6.7 mmol/L. Prompt treatment of this abnormality allowed this patient to undergo surgery the next day uneventfully. A paradoxical, critical increase in potassium can result from a single 1000-mg iv dose of acetazolamide.

Wong, Ashley V.; Balakrishnan, Karthik; Nemergut, Michael E.

doi: 10.1213/XAA.0000000000001151pmid: 31850923

We present the case of a 3-year-old female with multiple congenital anomalies, including postprandial otorrhea, who developed the inability to be mask ventilated secondary to a combination of velopharyngeal insufficiency and tympanic membrane perforation. When applied by mask, positive pressure ventilation was observed to preferentially escape the patient’s left ear, resulting in significant air leak, insufficient tidal volumes, hypoventilation, and severe hypoxemia. The problem was remedied by the insertion of a finger into the patient’s external auditory meatus, which controlled the air leak until the surgical team could provide definitive surgical correction of the velopharyngeal insufficiency and nasopharyngeal reflux.

Deguchi, Yoshihiko; Seki, Hiroyuki; Tamaki, Hiroaki; Ouchi, Takashi

doi: 10.1213/XAA.0000000000001152pmid: 31815772

Fibrodysplasia ossificans progressiva (FOP) is a rare hereditary disorder causing neck stiffness, ankylosis of temporomandibular joints, and severe restrictive respiratory dysfunction due to progressive heterotopic ossification of the connective tissue. Herein, we report a case of successful airway and anesthesia management using a high-flow nasal cannula (HFNC) in a 51-year-old man with FOP undergoing partial bone resection of the right greater trochanter of the femur. Although general anesthesia with awake fiberoptic nasotracheal intubation has been described as the gold standard, HFNC may yield another potentially viable option for patients undergoing a surgical procedure that does not involve the airway.

Drew, Thomas; Blackstock, Adam; Aron, Jonathan

doi: 10.1213/XAA.0000000000001153pmid: 31842196

We describe a hepatic laceration and subsequent anterior spinal artery syndrome in a 21-year-old man, secondary to prolonged cardiopulmonary resuscitation with a Lund University Cardiac Assist System (LUCAS2) mechanical cardiac compression device. We briefly review the current literature pertaining to hepatic injury from trauma due to cardiopulmonary resuscitation. The etiology of the anterior spinal artery syndrome in this patient is discussed. This case highlights that intra-abdominal causes of hypotension should be considered in patients after a prolonged resuscitation attempt. Extending focused cardiac ultrasound to exclude intra-abdominal free fluid should be routinely considered in these patients.

Endermann, Susann; Korte, Wolfgang; Filipovic, Miodrag

doi: 10.1213/XAA.0000000000001155pmid: 31842198

A 60-year-old woman presented with extensive swelling in the throat and impending airway obstruction. Following a well-established 2-step flexible bronchoscopic intubation procedure, a computed tomography scan identified a large hematoma compromising the airway. Laboratory testing confirmed the diagnosis of acquired hemophilia A (AHA), a rare condition that can potentially be life-threatening, particularly when it results in airway obstruction. The risk of fatal bleeding is substantial when difficult airway management guidelines call for a surgical airway. This case report describes the essentials of hemostatic treatment of AHA and our approach to the management of a difficult airway.

Yoshikawa, Mizuki; Shinomura, Tetsutaro; Kishimoto, Kaya; Uga, Hisatoshi

doi: 10.1213/XAA.0000000000001156pmid: 31842195

Hyaline fibromatosis syndrome (HFS) is a rare autosomal recessive disorder characterized by hyaline fibrous depositions in the skin and internal organs. Contractured joints and gingival hypertrophy make airway management difficult in patients with HFS, while trunk deformities complicate surgical positioning. A 56-year-old woman with HFS underwent laparoscopic colectomy for sigmoid colon cancer. Her airway was secured by awake fiberoptic intubation, and general anesthesia was maintained uneventfully. This report discusses the oldest reported patient with HFS and is the first to describe the management of epidural anesthesia in a patient with HFS.

Mabry, Christian; Perelman, Seth; Kim, Jung T.; Blitz, Jeanna D.

doi: 10.1213/XAA.0000000000001131pmid: 31770131

We present a process map for the implementation of a program to treat preoperative anemia utilizing 1 existing anesthesiologist in the preoperative evaluation clinic. In the first 7 months postimplementation, 342 patients were screened for anemia, 166 were diagnosed, and 107 were treated. The mean increase in hemoglobin in treated patients was ~2 g/dL (range 0–4.9 g/dL). Two patients’ surgeries were delayed in favor of treatment and 3 surgical patients, who had received 2 complete iron infusions, received an intraoperative transfusion. The total revenue generated for the institution was enough to subsidize the cost of an additional anesthesiologist.

Niyogi, Subhrashis Guha; Mandal, Banashree; Dogra, Neeti; Mishra, Anand Kumar

doi: 10.1213/XAA.0000000000001130pmid: 31789824

Supplemental Digital Content is available in the text.