A&A practice
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We present a rare case of a newborn with spontaneous, noniatrogenic arterial thromboembolism in the right brachial artery and accompanying ischemic changes to the right upper extremity, who was successfully treated with microsurgical intervention and ultrasound-guided infraclavicular brachial plexus block with a continuous infusion of ropivacaine for 48 hours. This case report highlights the emerging role of both the microsurgeon and anesthesiologist in management of spontaneous neonatal arterial thromboembolism.
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Severe upper airway obstruction is commonly managed with surgical tracheostomy under local anesthesia. We present a 49-year-old woman with postradiotherapy laryngeal fixation and transglottic stenosis for dilation of a pharyngeal stricture who refused elective tracheostomy. A 2-stage technique was used, which involved an awake fiberoptic intubation, followed by the transtracheal insertion of a Cricath needle and ventilation using an ejector-based Ventrain device. We discuss management aspects of this clinical scenario and the principles by which the Ventrain works.
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We report 3 cases of thoracic surgery that required 1-lung ventilation where venovenous extracorporeal membrane oxygenation was prophylactically used because severe hypoxemia and ventilatory failure were anticipated intraoperatively. The surgery was successfully completed in all 3 cases. However, we had to withdraw the extracorporeal membrane oxygenation support in 1 case because of uncontrollable hemorrhage. Venovenous extracorporeal membrane oxygenation is a feasible option when severe hypoxemia and/or ventilatory failure is anticipated during 1-lung ventilation.
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A rare autosomal recessive disorder caused by mutations in the B3GALT6 gene on chromosome 1p36 results in deficiency of β-1,3-galactosyltransferase 6, an enzyme critical for glycosaminoglycan biosynthesis. Defects in this gene result in a phenotype that has features of both skeletal dysplasia and a connective tissue disorder. The anesthetic considerations for children with this disorder have not previously been described. We report a collaborative, multidisciplinary approach to the perioperative care of a child with B3GALT6 mutations with severe phenotypic expression.