A&A practice
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Case Reports
Echo Findings of Intraoperative Surgical Glue Remnant on the Aortic Valve: A Case Report.
Surgical adhesive agents are frequently applied to reinforce aortic sutures in cardiac and aortic surgery. They are thought to provide hemostasis and safely and effectively reduce morbidity. ⋯ For detection of such surgical glue remnants, and to prevent associated serious potential complications, comprehensive transesophageal echocardiography is important. If surgical glue is applied during operative procedures, the heart and aorta should be carefully examined by transesophageal echocardiography.
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A patient recently treated with surgery and radiation for oropharyngeal cancer presented with impending hypoxic respiratory and cardiac arrest in a difficult airway scenario. A CriCath cannula in combination with the Ventrain device and its active expiratory ventilation technology enabled oxygenation and ventilation for 60 minutes until a surgical airway was established. This case report is the first to describe the intended use of Ventrain technology in an emergent "can't ventilate-can't intubate" scenario.
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The treatment for aortic stenosis is evolving rapidly with new developments in transcatheter aortic valve replacement (TAVR). While the procedure was initially performed under general anesthesia with invasive monitoring and transesophageal echocardiography, recent trends have shifted toward less invasive strategies. ⋯ This case series describes 3 patients who underwent subclavian TAVR under combined pectoralis and interscalene blocks. All patients tolerated the procedure without complication, requiring no airway manipulation and minimal postoperative analgesia.
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Tetra-amelia is a rare congenital disorder characterized by the absence of limbs. We describe the anesthetic management of a 29-year-old woman with tetra-amelia who underwent general anesthesia for tympanomastoidectomy with meatoplasty for an extensive right ear cholesteatoma. Anesthetic challenges related to tetra-amelia include difficult intravenous access, lack of sites for blood pressure monitoring, and possible difficult airway management due to craniofacial anomalies. Our case report focuses on the complex establishment of iliac artery access for invasive blood pressure monitoring by initially cannulating the carotid artery.
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Providing analgesia for patients with anterior rib and sternum fracture has been addressed from various types of modalities. Regional anesthesia via epidurals or peripheral nerve blocks, opiates, and other forms of multimodal pain regimens have been used. ⋯ In this case series, we describe the pectointercostal fascial block as another tool to treat patients with anterior rib and sternal fracture with polytraumatic injuries. All 3 of the block's successes were evident by improvement in the respiratory status of each patient.