A & A Case Reports

Hollifield, Lauren C.; Maguire, Margaret E.; Mandelbaum, Tal; Lee, Allison J.

doi: 10.1213/xaa.0000000000001867pmid: N/A

The Senning procedure is a palliation technique for addressing dextro-transposition of the great arteries; deoxygenated blood is redirected to the left ventricle, making the right ventricle the systemic ventricle. The physiologic increase in cardiac output during pregnancy may place additional stress on the right ventricle and given the existence of atrial scar tissue, trigger arrythmias. Because the technique was gradually abandoned starting in the 1970s, few remaining patients of child-bearing age remain. We emphasize here the importance of interdisciplinary team planning for delivery. Preparation for possible arrhythmia and potential decompensation in right ventricular function are essential.

Garre, Sandeep; Ayya, Syama Sundar; Ammanabrolu, Bhargav Ram; CH, Rama Krishna Prasad; Sangineni, Kalyani Surya Dhana Lakshmi

doi: 10.1213/xaa.0000000000001874pmid: 39584716

Spread of drugs in the epidural space may be unpredictable. The differential diagnosis of unilateral hemiparesis could be due to the unilateral spread of the drug, spinal epidural hematoma, intraspinal hematoma, and spinal cord injury. Atypical distribution of local anesthetic can occur due to lateral displacement of the epidural catheter, patient positioning, or the presence of an epidural septum. We present a case of atypical spread of epidural local anesthetic causing hemiparesis. It emphasizes the need for careful monitoring of sensory levels on both sides and provides insight into the causes of unilateral drug spread in the epidural space.

Sarkar, Arin Gopal; Chilakapati, Sirisha; Mohammed, Sadik; Das, Anupam; Rajagopal, Rengarajan

doi: 10.1213/xaa.0000000000001869pmid: 39584727

Point-of-care ultrasound (POCUS) has established its role as a “third eye of a clinician” by virtue of its ability to provide real-time visual information. The present case highlights the role of POCUS in an 11-year-old girl with a misplaced hemodialysis catheter scheduled for surgical exploration with the removal of the catheter and direct arterial repair.

Özdemir, İrem; Sincer, Yasemin; Yaylak, Doruk; Aygün, Elif; Tülümen, Erol; Şentürk, Evren

doi: 10.1213/xaa.0000000000001865pmid: 39513625

Takotsubo cardiomyopathy (TCM) is a reversible condition characterized by apical ballooning of the left ventricle, primarily triggered by catecholamine discharge due to stress. Patients may present with symptoms similar to acute coronary syndrome or with refractory ventricular arrhythmias such as QT prolongation, ventricular tachycardia, and ventricular fibrillation. We report a case of TCM with prolonged QT intervals and refractory ventricular arrhythmias, triggered by noncardiac systemic insult, that responded successfully to stellate ganglion block (SGB). This case highlights the potential of SGB as an effective intervention for managing refractory arrhythmias in TCM patients.

Nieb, Jacob M.; Garcia Tomas, Vicente; Chen, Liting

doi: 10.1213/xaa.0000000000001864pmid: 39513630

Thoracic epidural analgesia is commonly used for postoperative analgesia for abdominal and thoracic surgeries. One complication of thoracic epidural catheter placement is a malpositioned catheter, such as in the subarachnoid, subdural, or intrapleural space. We present a case of unintentional posterior mediastinal catheter placement. The catheter produced a sensory level and analgesic benefit and was only identified incidentally on computed tomography (CT) imaging. This case highlights another possible anatomic location for unintentional catheter placement, which may be more common than reported, as it functioned as an epidural catheter by all clinical metrics and would not have been identified without imaging.

Silva, Marta Correia; Bernardino, Ana; Vieira, Ana Luísa

doi: 10.1213/xaa.0000000000001872pmid: 39584717

PHARC syndrome (polyneuropathy, hearing loss, ataxia, retinitis pigmentosa, and cataracts) is a rare autosomal recessive disease, caused by genetic mutation of the ABHD12 gene. This syndrome is still not well known and can be misdiagnosed, especially in the early stages, as it can be easily confused with other neurodegenerative diseases. We present the first description of the anesthetic management of 2 siblings with PHARC syndrome who underwent unilateral cochlear implantation.

Singla, Deepak; A, Anija; Aneja, Parag; Singh, Shreya

doi: 10.1213/xaa.0000000000001866pmid: 39480043

In conjoined twins when one of the twins is incompletely formed and is dependent on the healthy counterpart for survival, they are described as heteropagus (parasitic) twins. Rachipagus is a type of parasitic twin joined at the spine above the sacrum. Such neonates can present with complex problems related to anesthesia. We encountered one such infant for a routine contrast-enhanced computed tomography (CECT) angiography under sedation. The infant was resistant to multiple anesthetic drugs like fentanyl, propofol, and ketamine. Later general anesthesia was induced with thiopentone sodium, and the procedure went on uneventfully.

Joy, Joydip; Kollman, Patrick; Alsaden, Mohamed-Rida A.

doi: 10.1213/xaa.0000000000001863pmid: 39480031

This case report highlights a unique instance of spinal myoclonus after neuraxial anesthesia. It aims to inform anesthesiology providers, enhancing their ability to identify, manage, and potentially prevent similar outcomes in patients at risk.

Jones, James Harvey

doi: 10.1213/xaa.0000000000001877pmid: 39584724

Transporting spontaneously ventilating adults with tracheostomies from the operating room (OR) or other anesthetizing locations to the intensive care unit (ICU) or other recovery locations presents significant challenges, as traditional T-pieces may not be readily available. This article describes a novel modification to the Ayre’s T-piece, designed to address this gap by using readily available equipment. The modification integrates a 3-mL syringe, a size 7.0 endotracheal tube (ETT) connector, and oxygen tubing from an adult under-the-chin style facemask while adapting the expiratory and inspiratory limbs of the anesthesia circuit.