A & A case reports
-
Case Reports
The Role of Sugammadex in Symptomatic Transient Neonatal Myasthenia Gravis: A Case Report.
We describe the case of a 3-week-old boy with pyloric stenosis who presented for laparoscopic pyloromyotomy in the setting of symptomatic transient neonatal myasthenia gravis. The patient received muscle relaxation with rocuronium, and neuromuscular blockade was successfully reversed with sugammadex with recovery guided by train-of-four monitoring. He was extubated uneventfully without complications. Because sugammadex binds directly to rocuronium rather than interfering with acetylcholine metabolism, it might provide a good option for reversal of neuromuscular blockade in transient neonatal myasthenia gravis.
-
Case Reports
Brachiocephalic Vein Perforation During Cannulation of Internal Jugular Vein: A Case Report.
We report a rare complication of right brachiocephalic vein perforation during ultrasound-guided cannulation of the right internal jugular vein (IJV) in a patient with a tortuous common carotid artery (CCA). We suspect that the tortuous CCA displaced the IJV, which caused misplacement of the J-tip guidewire into the subclavian vein. ⋯ This was diagnosed by videothoracoscopy. Anesthesiologists should be aware of the possibility of guidewire malposition during IJV catheterization in patients with a tortuous CCA.
-
Case Reports
Malignant Hyperthermia in a Morbidly Obese Patient Depletes Community Dantrolene Resources: A Case Report.
During resection of a duodenal carcinoid tumor, a 28-year-old morbidly obese woman developed suspected malignant hyperthermia. This hypermetabolic state posed a diagnostic challenge given the similar intraoperative presentation of carcinoid crisis and malignant hyperthermia. ⋯ Current dantrolene dosing recommendations are based on actual body weight despite a paucity of literature in obese patients. We speculate that the prolonged need for dantrolene redosing was from the continuous release of the volatile anesthetic from the patient's adipose tissue.
-
Early diagnosis of aortic dissection is important to reduce mortality, with surgical management representing standard treatment. Current methods of diagnosing type A aortic dissection include computed tomography angiography (CTA), magnetic resonance imaging, catheter-based arteriography, and transesophageal echocardiography. ⋯ We present a case of a patient who was diagnosed with type A aortic dissection by CTA, but was found to not have an aortic dissection by transesophageal echocardiography under general anesthesia, preventing an unnecessary sternotomy. The echocardiographic findings suggested CTA artifact.