Desmopressin (DDAVP), a synthetic analog of vasopressin, has been used in patients with von Willebrand disease (VWD), mild hemophilia A, and platelet dysfunction to reduce the risk of bleeding associated with surgical and interventional procedures. We report the case of a patient with VWD presenting with a bulging disc and radicular pain that underwent transforaminal epidural steroid injections. Her course was complicated with the interval development of headaches and dizziness symptomatic of moderate hyponatremia, likely due to excessive fluid intake. This report highlights a relatively rare side effect of DDAVP when used for prophylaxis in patients with VWD and reinforces the need for vigilance in these patients.

Talal W. Khan

Abdulraheem Yacoub

Pitfalls in Interventional Pain Medicine: Hyponatremia after DDAVP for a Patient with Von Willebrand Disease Undergoing an Epidural Steroid Injection

Millions of passengers board commercial flights every year. Healthcare providers are often called upon to treat other passengers during in-flight emergencies. The case presented involves an anesthesia resident treating a tracheostomy-dependent infant who developed hypoxemia on a domestic flight. The patient had an underlying congenital muscular disorder and was mechanically ventilated while at altitude. Although pressurized, cabin barometric pressure while at altitude is less than at sea level. Due to this environment patients with underlying pulmonary or cardiac pathology might not be able to tolerate commercial flight. The Federal Aviation Administration (FAA) has mandated a specific set of medical supplies be present on all domestic flights in addition to legislature protecting &#x201c;Good Samaritan&#x201d; providers.

Jason Quevreaux

Christopher Cropsey

In-Flight Hypoxemia in a Tracheostomy-Dependent Infant

Continuous brachial plexus nerve block catheters are commonly inserted for postoperative analgesia after upper extremity surgery. Modifications of the insertion technique have been described to improve the safety of placing an infraclavicular brachial plexus catheter. Rarely, these catheters may become damaged or entrapped, complicating their removal. We describe a case of infraclavicular brachial plexus catheter entrapment related to differences in arm positioning during catheter placement and removal. Written authorization to obtain, use, and disclose information and images was obtained from the patient.

Eric Kamenetsky

Rahul Reddy

Mark C. Kendall

Antoun Nader

Jessica J. Weeks

Effect of Arm Positioning on Entrapment of Infraclavicular Nerve Block Catheter

Reports focusing on biomedical principlism and the role of anaesthesiologists in palliative care are rare. We present the case of a newborn with multiple craniofacial anomalies and a diagnosis of ADAM &#x201c;sequence,&#x201d; in which surgical removal of placental adhesions to the dura mater and the correction of meningocele was not indicated due to the very short life expectancy. After 48 hours, the odor from the placenta indicted a necrotic process, which prevented the parents from being close to the child and increased his isolation. Urgent surgery was performed, after which the newborn was transported to the ICU and intubated under controlled mechanical ventilation. The patient died a week later. The principles of beneficence, nonmaleficence, justice, and respect for autonomy are simultaneously an inspiratory and regulatory framework for clinical practice. Although only necessary procedures are defended, which suggests a position contrary to invasive interventions at the end of life, sometimes they are the best palliative measures that can be taken in cases like the one described here.

Alberto Vieira Pantoja

Maria Em&#xed;lia Gon&#xe7;alves Estevez

Bruno Lima Pessoa

Fernando de Paiva Ara&#xfa;jo

Bruno Mendon&#xe7;a Barcellos

Ciro Augusto Floriani

Marco Antonio Cardoso de Resende

The Anaesthesiologist and Palliative Care in a Newborn with the Adam &#x201c;Sequence&#x201d;

Myotonic Dystrophy (DM) affects multiple organ systems. Disorders such as hyperthyroidism, progressive musculoskeletal weakness, cardiac dysrhythmias, hypoventilation, and cognitive-behavioral disorders may be present in these patients. Thorough preoperative assessment and anesthetic planning are required to minimize the risk of anesthetic complications. Patients with DM can exhibit exquisite sensitivity to sedatives, neuromuscular blocking agents, and volatile anesthetics, resulting in potential postoperative complications. There is limited literature available on successful anesthetic techniques for the DM patient. We present this case report to add to our current fund of knowledge.

Ramon Go

David Wang

Danielle Ludwin

Anesthetic Considerations in a Patient with Myotonic Dystrophy for Hip Labral Repair

Pheochromocytomas and extra-adrenal paragangliomas are catecholamine-secreting tumors that rarely occur in pregnancy. The diagnosis of these tumors in pregnancy can be challenging given that many of the signs and symptoms are commonly attributed to preeclampsia or other more common diagnoses. Early diagnosis and appropriate management are essential in optimizing maternal and fetal outcomes. We report a rare case of a catecholamine-secreting tumor in which diagnosis occurring at the time labor was being induced for concomitant preeclampsia with severe features. Her initial presentation in hypertensive crisis with other symptoms led to diagnostic workup for secondary causes of hypertension and led to eventual diagnosis of paraganglioma. Obtaining this diagnosis prior to delivery was essential, as this led to prompt multidisciplinary care, changed the course of her clinical management, and ultimately enabled good maternal and fetal outcomes. This case highlights the importance of maintaining a high index of suspicion for secondary causes of hypertension and in obstetric patients and providing timely multidisciplinary care.

Sasima Dusitkasem

Blair H. Herndon

Dalton Paluzzi

Joseph Kuhn

Robert H. Small

John C. Coffman

From Bad to Worse: Paraganglioma Diagnosis during Induction of Labor for Coexisting Preeclampsia

Brainstem anesthesia is a potentially life-threatening complication of regional ophthalmic anesthesia. This case report chronicles an unusual presentation of brainstem anesthesia following an eye block. The unique features of this case were the presenting symptoms of deafness and slurred speech in the absence of loss of consciousness, respiratory depression, or contralateral ophthalmoplegia. This report underscores two key points: first, the importance of ongoing patient monitoring after performance of an eye block; second, the exigency of supportive therapy in suspected cases of brainstem anesthesia.

Howard D. Palte

Don P. Hoa

Aldo Pavon Canseco

Surdity in the OR: An Unusual Case of Brainstem Anesthesia

Introduction. Cervicogenic headache is characterized by unilateral neck or face pain referred from various structures such as the cervical joints and intervertebral disks. A recent study of patients with cervical pain showed significant pain relief after cervical medial branch neurotomy but excluded patients with C1-2 joint pain. It remains unclear whether targeting this joint has potential for symptomatic relief. To address this issue, we present a case report of C1-2 joint ablation with positive outcomes. Case Presentation. A 27-year-old female presented with worsening cervicogenic headache. Her pain was 9/10 by visual analog scale (VAS) and described as cramping and aching. Pain was localized suboccipitally with radiation to her jaw and posterior neck, worse on the right. Associated symptoms included clicking of her temporomandibular joint, neck stiffness, bilateral headaches with periorbital pain, numbness, and tingling. History, physical exam, and diagnostic studies indicated localization to the C1-2 joint with 80&#x25; decrease in pain after C1-2 diagnostic blocks. She underwent bilateral intra-articular radiofrequency ablation of the C1-C2 joint. Follow-up at 2, 4, 8, and 12 weeks showed improved function and pain relief with peak results at 12 weeks. Conclusion. Clinicians may consider C1-C2 joint ablation as a viable long-term treatment option for cervicogenic headaches.

Charles A. Odonkor

Teresa Tang

David Taftian

Akhil Chhatre

Bilateral Intra-Articular Radiofrequency Ablation for Cervicogenic Headache

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Case Reports in Anesthesiology publishes case reports and case series related to anesthetic administration and efficacy, preoperative and postoperative considerations, perioperative care, critical care etc.

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Case Reports in Anesthesiology - Table of contents 2017

title

Case Reports in Anesthesiology publishes case reports and case series related to anesthetic administration and efficacy, preoperative and postoperative considerations, perioperative care, critical care etc.

Case Reports in Anesthesiology