A & A case reports
-
Conversion of hemiblock to complete heart block by intraoperative motor-evoked potential monitoring.
Intraoperative monitoring of nervous system pathways, including assessing the integrity of descending motor pathways with motor-evoked potentials, is often performed in intracranial and spine operations to reduce the risk of iatrogenic neurological impairment. We present a case in which intraoperative monitoring with motor-evoked potentials resulted in complete heart block in a patient with a history of hemiblock. Neuromonitoring has been associated with arrhythmias in patients with ostensibly normal conduction systems, and we propose that monitoring personnel, anesthesiologists, and surgeons need to be aware of this risk and exercise caution when monitoring motor-evoked potentials in patients with known conduction deficits.
-
We report a significant complication that occurred during double guidewire insertion. The first guidewire (GW1) was inserted under ultrasonographic guidance, whereas the second guidewire (GW2) was inserted by the landmark-based method. ⋯ The first guidewire was found to be pointing in a cranial direction, indicating the manner in which the second guidewire's puncture needle had penetrated it. Thus, when double cannulation is performed, guidewire position should be confirmed.
-
Placing a flow-directed pulmonary artery catheter (PAC) can be difficult and lead to serious complications. We present the case of an attempted PAC insertion in a patient undergoing implantation of a left ventricular assist device. ⋯ This malposition could not be visualized intraoperatively by transesophageal echocardiography. The PAC was replaced in the operating room after the left ventricular assist device was implanted.
-
We present the case of a neonate with congenital tracheal stenosis (1.4-mm diameter) who came to the operating room as both an unanticipated and anticipated case of difficult airway management. We discuss the airway management of newborn children with congenital tracheal stenosis, and rescue options for the difficult airway in very small children.