A&A practice
-
Case Reports
Electroencephalogram Suppression Despite Extremely Low-Dose Anesthetic During Cardiac Surgery: A Case Report.
A prominent feature of electroencephalogram (EEG) under general anesthesia is anteriorization of α waves. We report the case of a 63-year-old man anesthetized for coronary artery bypass grafting in whom the NeuroSENSE-processed EEG monitor recorded only δ waves in the absence of α frequencies, along with high EEG suppression despite extremely low doses of anesthetics during the whole procedure. The patient fully recovered from anesthesia 2 hours after the procedure and showed neither awareness nor neurological complications. This atypical EEG pattern under low concentration of anesthetics may be an intraoperative marker of a specific brain phenotype.
-
Case Reports
Peripheral Nerve Block Efficacy on Refractory Neuralgia Complicating Ramsay Hunt Syndrome: A Case Report.
Several case studies have suggested the usefulness of peripheral nerve blocks in the management of various types of chronic pain that are unresponsive to standard medical treatment. We report here the case of a patient with severe neuralgia, secondary to Ramsay Hunt syndrome that was refractory to standard drug therapy. ⋯ Despite transient facial paralysis, pain was markedly reduced for 3 months with self-reported improved quality of life. To our knowledge, this block has never been described previously.
-
Case Reports
Large Iatrogenic Tracheal Injury From Attempted Endotracheal Cuff Leak Remedy: A Case Report.
Continuous insufflation of oxygen into the pilot balloon of an endotracheal tube has been documented as a viable method to fix an incompetent endotracheal tube cuff. We present a case of a large iatrogenic tracheal injury resulting from an improvised cuff leak management device. Valuable lessons are discussed to prevent similar incidents.
-
We describe a patient with acute on chronic respiratory failure after a cardiac arrest who was cannulated to venoarterial extracorporeal membrane oxygenation. The patient developed right-sided interstitial emphysema with air leak and left-sided hemothorax with secondary atelectasis. ⋯ The patient's overall pulmonary function improved, and he was successfully decannulated from extracorporeal membrane oxygenation. In conclusion, differential lung ventilation may be performed in patients on extracorporeal membrane oxygenation with disparate lung disease as an alternative ventilation strategy.
-
It is well known that antithrombin (AT) deficiency results in decreased heparin sensitivity, also known as "heparin resistance." However, non-AT-mediated causes of heparin resistance are generally poorly characterized and less prevalent in the literature. We present 2 case reports of non-AT-mediated heparin resistance during cardiac surgery due to paraproteinemia and hyperfibrinogenemia. These cases highlight the challenges posed by unusual conditions in achieving adequate anticoagulation for cardiopulmonary bypass (CPB). The pros and cons of the treatment selections for these cases are discussed, and the potential complications of large doses of unfractionated heparin are considered.