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  • 机译 巨大心包膜囊肿压迫右心房的患者的麻醉管理
    摘要:Pericardial cysts are rare mediastinal cysts composed of a single fluid-filled mesothelial layer and can be congenital in origin or develop secondary to pericarditis, trauma, or infection. Although most pericardial cysts are asymptomatic, life-threatening complications can occasionally occur. We report on a 57-year-old man with an asymptomatic 9 cm pericardial cyst that was incidentally found as an abnormal cardiac silhouette on routine chest radiography. Further imaging confirmed the presence of a pericardial cyst that was compressing the right atrium. The patient underwent successful video-assisted thoracoscopic removal of the pericardial cyst under general anesthesia. The patient's postoperative course was uneventful and he was discharged on postoperative day 1 in a stable condition. To our knowledge, this is the first report regarding the anesthetic management of a patient with a giant pericardial cyst undergoing thoracic surgery. Knowledge regarding the perioperative challenges associated with the removal of pericardial cysts can prevent complications and improve patient outcomes.
  • 机译 急救经食道超声心动图诊断出的术中肺栓塞在一名肥胖的患者中发生了车祸,该患者正在接受整形外科手术
    摘要:A case of intraoperative pulmonary embolism diagnosed by rescue transesophageal echocardiography in a morbidly obese patient undergoing orthopedic surgery following motor vehicle crash, who developed acute and persistent tachycardia, hypotension, and reduction of end-tidal CO2 during general and regional anesthesia, is described.
  • 机译 剖宫产时严重左心室收缩功能不全患者的抢先式ECMO插管
    摘要:Obstetric patients with heart failure undergoing cesarean delivery are high risk and the perioperative care of these patients poses significant multidisciplinary challenges. In contrast to the nonobstetric patient population the potential role of mechanical circulatory support in parturients with heart failure is not well established and the use of extracorporeal membrane oxygenation (ECMO) has rarely been reported. We report the case of a super morbidly obese patient with decompensated heart failure, pulmonary hypertension, and superimposed preeclampsia undergoing preemptive ECMO cannulation for urgent cesarean delivery.
  • 机译 Sugammadex给药后,用于超级肥胖患者的右美托咪定输注后立即逆转深层阻滞的短暂性心搏停止
    摘要:Sugammadex is increasingly used to reverse aminosteroid neuromuscular blocking agents. Dosing is calculated based on actual body weight, even for those who are obese. We report a case where a super obese patient (BMI 58.5 kg/m2) developed asystole, following coadministration with dexmedetomidine, for rapid reversal after deep blockade. Although 16mg/kg of actual body weight is recommended for prompt reversal of deep blockade, dosing adjustments may be prudent in the obese population, especially when used in conjunction with other negative chronotropic agents.
  • 机译 偶然发现伴有恶性高热的遗传变异对接受CABG的患者进行麻醉管理的变化
    摘要:Malignant hyperthermia (MH) is a rare life-threatening hypermetabolic muscular disorder with a high mortality rate. Three genes, RYR1, CACNA1S, and STAC3, have been associated with MH susceptibility. Multiple genetic variants have been identified in these three genes. Some of those variants were pathogenic, but many others are yet to be tested. Such uncertainty can make it challenging for anesthesia providers as there is currently no anesthesia guideline for each genetic variant in patients who have neither clinical nor family history of MH. With the increasing popularity of whole exome sequencing, anesthesia providers will likely face such challenges more often as many patients may have genetic variations of unknown clinical significance in their RYR1, CACNA1S, or STAC3 genes. Here we describe change of anesthesia management for a patient who had an incidental finding of a genetic variant in RYR1 gene undergoing an elective coronary artery bypass surgery.
  • 机译 深低温循环骤停的重症肌无力患者全主动脉弓置换术的麻醉处理
    摘要:The anesthetic management of myasthenia gravis patients undergoing cardiac or aortic surgery under cardiopulmonary bypass, especially with deep hypothermic circulatory arrest, is challenging. We describe a case of successful anesthetic management of a myasthenia gravis patient undergoing total arch replacement with deep hypothermic circulatory arrest under neuromuscular monitoring and complete reversal of the action of neuromuscular blocking drugs by sugammadex. The present case suggests that patients with well-controlled myasthenia gravis might be safely managed in cardiac or aortic surgery under cardiopulmonary bypass with deep hypothermic circulatory arrest.
  • 机译 强直性肌营养不良症和麻醉挑战:病例报告和审查。
    摘要:Providing anesthesia to patients with myotonic dystrophy (DM) can be very challenging due to the multisystemic effects of the disease and extreme sensitivity of these patients to sedatives, opioids, and anesthetic agents. Other factors such as hypothermia, shivering, or mechanical or electric stimulation during surgery can precipitate myotonia which is difficult to abolish and can lead to further complications. Generally, local or regional anesthesia is preferred to avoid the complications associated with general anesthesia in this group. However there are several case reports of successful use of general anesthesia (with or without volatile agents and with or without opioids). These general anesthetic cases led to postoperative admission to the regular floor or ICU. We present a case of a woman with a history of DM who underwent robotic assisted laparoscopic hysterectomy under general anesthesia and was discharged home on the same day.
  • 机译 子痫前期诱发的肝功能不全并发弥散性血管内凝血和胎盘早剥:一例病例并文献复习
    摘要:A 33-year-old primigravida at 32-week gestation was admitted to labor and delivery complaining of severe right upper quadrant pain and worsening coagulopathy. We report the anesthetic and obstetrical management of a complex case of a parturient with a mixed picture of hemolysis, elevated liver enzymes and low platelets who was delivered under general anesthesia further complicated by Disseminated Intravascular Coagulopathy (DIC) and placental abruption.
  • 机译 Graves病患者因严重药物不依从而计划进行甲状腺切除术并因发生严重的甲状腺风暴而高危风险:麻醉和手术考虑
    摘要:In patients with failed hormone regulation who are scheduled for indispensable total thyroidectomy, the risk of thyroid storm with severe end-organ complications has to be anticipated. This case report presents the successful surgical and anaesthesiological management of a patient with Graves' disease, without any signs of perioperative thyroid storm. Possible recommendations for treatment are presented.
  • 机译 全身麻醉诱导期间意外的张力性气胸-血胸
    摘要:Tension pneumothorax during general anaesthesia is a rare but possibly deleterious event, especially where predisposing factors are absent or unknown, making diagnosis even challenging. We describe a case of a healthy middle-aged woman, who was planned to receive general anaesthesia for total thyroidectomy. After intubation, the patient experienced marked hypoxemia (SpO2=75%), hypotension, and tachycardia. Manual positive pressure ventilation seemed to worsen hypoxemia and tachycardia, while apnoeic oxygenation through circle system with valve open slightly improved cardiorespiratory collapse. The effect of positive ventilation, along with the absence of breath sounds in the right hemithorax and cardiorespiratory collapse, established the diagnosis of tension pneumothorax, managed immediately with emergency thoracentesis and placement of a thoracostomy tube. The patient was improved and pneumothorax was confirmed with chest X-ray and CT. The latter also confirmed the presence of bilateral multiple bullae. The operation was postponed and the patient was extubated a few hours later, in good condition. After thorough evaluation for any systemic disease, which was negative, the patient underwent two-stage thoracotomy for bullectomy.
  • 机译 高频脊髓刺激器植入后新发作的耳鸣
    摘要:The most common complications of spinal cord stimulation (SCS) therapy are generally related to surgical site infection and hardware malfunction. Less well understood are the adverse neurological effects of this therapy. We present the case of a patient who underwent placement of a Senza HF10 high-frequency spinal cord stimulator with subsequent development of tinnitus, vertigo, intermittent involuntary left facial twitches, and perioral numbness. These symptoms resolved following deactivation of her device. To further explore these less common neurologic complications of SCS therapy, a review of literature and a review of the U.S. Food and Drug Administration Manufacturer and User Facility Device Experience database are included. Further research and investigation in this area are needed so that clinicians and patients may have more complete knowledge and understanding of the potential treatment-limiting complications of spinal cord stimulation.
  • 机译 使用J-Tip导丝和留置外围插入的中心静脉导管对困难的颈内中心静脉插管
    摘要:Central venous cannulation is a commonly performed procedure while managing critically ill patients; increasingly we encounter patients with indwelling wires or devices, like pacemakers, implantable cardioverter defibrillator devices, and peripherally inserted central venous catheters which complicate insertion of central venous catheters further. We present two cases where use of standard J-tip guidewire may have exacerbated the difficulty associated with internal jugular cannulation in presence of peripherally inserted central venous catheters. Recognition and avoidance of possible complications are crucial, and we discuss complexity posed by indwelling peripherally inserted central venous catheters and possible solutions.
  • 机译 永久左上腔静脉(PLSVC)与Azygos系统的连接:病例报告和临床意义
    摘要:Persistent left superior vena cava (PLSVC) is a rare anatomic variant that has a significant effect on the structure of the heart and venous system with clinical implications that are far-reaching. The presence of this variant is relevant to central venous catheter insertion, cardioverter-defibrillator placement, coronary artery bypass grafting, and numerous other medical procedures. In this report, we describe a rare case of PLSVC with a connection to the azygos system; notably, the vast majority of PLSVCs connect to the coronary sinus. We also discuss the anatomic and anesthetic considerations for individuals with this uncommon variant.
  • 机译 机器人子宫肌瘤切除术后大规模上半身和颈面部皮下气肿
    摘要:Subcutaneous emphysema is defined as the unintentional introduction of air or carbon dioxide in the subcutaneous tissues. The use of robotic surgical techniques has greatly expanded over the past decade specifically to treat intraperitoneal pathology. In general, advantages of these minimally invasive procedures are reported to decrease operating time, patient morbidity, and shorten hospital stay providing a safe alternative to traditional surgery. However, as with any surgery, potential complications may occur. We describe an unusual case of massive subcutaneous emphysema involving the upper body and cervicofacial region, with bilateral pneumothoraces following robotic intraperitoneal surgery. Written authorization was obtained from the patient.
  • 机译 难治的异丙酚辅助结肠镜检查期间伴有近端结肠扩张的爆炸性呕吐
    摘要:We present a case of explosive vomiting associated with the extensive manipulation of the proximal colon during a difficult colonoscopy procedure. The cause of vomiting in this case may have been multifactorial; however, proximal colonic distention was the most likely factor because the onset of vomiting coincided with proximal colonic manipulation and happened without any prodromal signs, coughing, and airway obstruction. Propofol, the sedative most commonly administered to the patient during colonoscopy, allows for a deep state of sedation, and consequently extensive colonic distention and scope manipulation. Colonic distention may lead to a higher risk of vomiting. We reviewed the neurocircuitry associated with vomiting and discussed why proximal colonic distention may increase the risk of vomiting. We emphasize vigilance during the manipulation of the proximal colon because vomiting increases the potential for aspiration pneumonitis and pneumonia in patients under deep propofol sedation with attenuated airway responses.
  • 机译 超声引导连续坐骨神经阻滞治疗急性疱疹性神经痛
    摘要:Herpes Zoster (HZ) is the reactivation of a well-known viral disease which manifests itself with painful skin lesions. An effective analgesic method during the acute phase of HZ can contribute to decrease the incidence of postherpetic neuralgia (PHN) by reducing neural sensitization. Sciatic nerve block (SNB) is useful in the management of distal lower extremity pain sustained by the sciatic nerve. We describe our experience with a continuous ultrasound guided subgluteus sciatic nerve block in a patient with herpetic neuralgia- (HN-) related refractory acute left leg pain.
  • 机译 腰部引流后丘脑梗塞的病例报告:围手术期中风的独特原因?
    摘要:In the case presented, a patient has an unexplained episode of hypertension during aneurysm clipping. Following the procedure, the patient was discovered to have bilateral thalamic infarctions unrelated to the vascular location of the aneurysm. After a review of the case, it becomes apparent that intracranial hypotension caused by lumbar over drainage of cerebrospinal fluid (CSF) is the likely cause of both the episode of intraoperative hypertension and the thalamic infarcts. It is often presumed that having an open dura protects against intracranial hypotension and subsequent herniation. We present this case to suggest that opening the dura might not be protective in all cases and anesthesiologists must pay particular attention to the rate of CSF drainage. Lumbar CSF drainage is a technique frequently employed during neurological surgery and it is important for anesthesiologists to understand the signs, symptoms, and potential consequences of intracranial hypotension from rapid drainage.
  • 机译 外伤性肋骨和脊柱骨折患者的双侧竖脊椎平面导管有效镇痛
    摘要:Pain management in trauma patients with acute rib and spine fractures presents a challenge for the anesthesiologist and achieving adequate analgesia is important in preventing pulmonary complications. Unfortunately, neuraxial techniques are often challenging or contraindicated due to spine fractures or coagulopathy. Erector spinae plane (ESP) blocks provide an alternative regional anesthetic technique to manage pain. We describe a case of bilateral ESP catheters placed intraoperatively after spinal instrumentation in a patient with bilateral rib and spine fractures sustained in a tractor rollover crash. Prior to surgery, the patient had inadequate pain control and poor respiratory function despite multimodal analgesia. With the addition of bilateral ESP catheters, the patient's pain control improved and he was weaned from respiratory support. ESP blocks have been shown to provide effective analgesia in patients with rib fractures; however, the utilization of these blocks has not been described in patients with spine fractures undergoing spinal instrumentation. Thus, ESP blocks provide a simple alternative to providing surgical and trauma analgesia when neuraxial techniques are contraindicated. The success of bilateral ESP catheters in our patient indicates a further area for application of ESP blocks in patients undergoing spine surgery with acute traumatic spine fractures.
  • 机译 肺动脉导管似乎被困在头骨中
    摘要:A pulmonary artery catheter is an important tool for the monitoring of hemodynamics in patients. Unfortunately, misplacement of a catheter tip may occur in the vasculature local to the intended placement. Misplacement of the catheter can be further complicated by entrapment at the unintended destination. We present a case of a misplaced and entrapped pulmonary artery catheter in a patient with worsening pulmonary disease. After multiple unsuccessful attempts to float the catheter, it was partially retracted and found to be stuck. Imaging showed the tip terminating in the right internal jugular vein at the level of the jugular foramen. It was initially suspected that the catheter had become looped, knotted, or otherwise entangled within the vasculature of the skull and surgical removal would be necessary. Before surgical removal was performed, it was instead determined that the catheter had become kinked and entrapped at the end of the introducer sheath, and noninvasive removal was accomplished by first removing the introducer sheath.
  • 机译 正常肾脏功能错误地保护我们时,ACE-I能否成为沉默的杀手?
    摘要:The current case report represents a warning against serious hyperkalaemia and acidosis induced by ACE-I during surgical stress while normal renal function could deceive the attending anaesthetist. Arterial gas analysis for follow-up of haemoglobin loss accidentally discovered hyperkalaemia and acidosis. Glucose-insulin and furosemide successfully corrected hyperkalaemia after 25 minutes and acidosis after 3 hours. These complications could be explained by a deficient steroid stress response to surgery secondary to suppression by ACE-I. Event analysis and database search found that ACE-I induced aldosterone deficiency aggravated by surgical stress response with an inadequate increase in aldosterone secretion due to angiotensin II deficiency as a sequel of ACE-I leading to defective secretion of H+ and K+. Furosemide is recommended to secrete H+ and K+ compensating for aldosterone deficiency in addition to other antihyperkalaemia measures. Anaesthetising an ACE-I treated patient requires considering ACE-I as a potential cause of hyperkalaemia and acidosis.

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