Left ventricular noncompaction (LVNC) is described as a cardiomyopathy with an increase in left ventricle trabeculations and recesses. We report a rare case of persistent pregnancy-acquired LVNC cardiomyopathy and review the anesthetic peripartum management strategies. A 33-year-old parturient was followed closely by the high-risk obstetric service for her second pregnancy. She had an unresolved LVNC cardiomyopathy that was diagnosed during her first pregnancy for which she had a caesarean section. Her symptoms included occasional palpitations and dyspnea. She was started on metoprolol and enoxaparin. A successful caesarean section was performed at 37 weeks gestation under regional anesthesia. Echocardiograms prior to and during the second pregnancy demonstrated persistence of the LV hypertrabeculations, LV systolic dysfunction, and a left ventricular ejection fraction (LVEF) of 35&#x0025;. Pregnancy-induced LV hypertrabeculations occur in a significant proportion of women, but most cases spontaneously resolve completely. Favorable maternal and fetal outcomes require multidisciplinary care and careful selection of the anesthetic technique and drugs that maintain stable hemodynamics.

Is&#x2019;haq Al-Aamri

Simone Derzi

Albert Moore

Natalie Bottega

Maria V. Ordo&#xf1;ez

Valerie Villeneuve

Roupen Hatzakorzian

Irreversible Acquired Noncompaction Cardiomyopathy in a Parturient with Corrected Atrial Septal Defect: A Case Report and Clinical Implications

Malignant hyperthermia is a rare pharmacogenetic disorder triggered by depolarizing muscle relaxant and potent volatile anesthetic agents. An MH crisis is an emergency and life-threatening event requiring early recognition and prompt management. Dantrolene is the specific antagonist of MH. The authors report the case of a 9-year-old boy who underwent an emergency bronchoscopy to remove a foreign body and developed masseter rigidity after succinylcholine and sevoflurane exposure. The anesthesia team diagnosed an MH event, and the event was managed immediately with supportive treatment, dantrolene, being administered within 10 minutes. The patient survived and had a good outcome without any complications. We suggest that it is essential for anesthesia providers to recognize the need for intraoperative vigilance, prompt recognition, and treatment, and dantrolene sodium should be readily available in every hospital.

Warangkana Lapisatepun

Supawan Arkarattanakul

Early Recognition and Treatment of Malignant Hyperthermia in Pediatric Patient during Bronchoscopy

A 20-year-old G1P0 patient at 38 weeks and 1 day of gestation was admitted for emergency cesarean delivery. Her past medical history was positive for cervicomedullary arteriovenous malformation (AVM) that ruptured three years before. Spontaneous vaginal delivery was contraindicated by neurosurgery. Aiming for cardiovascular stability and immediate reduction of sympathetic activity, a combined spinal epidural was successfully placed. An uneventful cesarean section was performed. The patient was transferred to the intensive care unit neurologically intact and discharged home after 8 days. This report describes an unusual anesthetic management of a patient with a large AVM in active labor.

Christiano dos Santos e Santos

David A. Joyner

Cristiane A. Tuma Santos

Bernadette E. Grayson

Arthur Calimaran

Douglas R. Bacon

Alternative to General Anesthesia for a Stat Cesarean Delivery in a Patient with a Large Arteriovenous Malformation Involving the Cervicomedullary Junction in Active Labor

ST elevations (STE) in the perioperative setting can result from a number of different etiologies, the most common and feared being acute coronary syndrome (ACS). However, other causes should be considered, as treatment may differ depending on the diagnosis. Here, we describe a case of STE and ventricular tachycardia in a patient at high risk for ACS. The patient had a prior diagnosis of coronary vasospasm; however, given pre-existing risk factors, much consideration and deliberation occurred prior to electing conservative therapy. This report provides an overview of perioperative vasospasm and other causes of STE, which anesthesiologists should be aware of.

Patrick J. Lindsay

Rachel C. Frank

Edward A. Bittner

Sheri Berg

Marvin G. Chang

ST Elevations and Ventricular Tachycardia Secondary to Coronary Vasospasm upon Extubation

ASA closed claims from 2000 to 2009 have shown that adverse respiratory events are more common in nonoperating room locations like endoscopy suite than in the operating room (44&#x0025; v/s 20&#x0025;). Here, we report a case of lung atelectasis which resulted in hypoxemia in a malnourished patient undergoing endoscopic procedure. It is crucial to identify the high-risk patients and monitor them appropriately in the postoperative phase. Continuous capnometry may offer additional benefit by identifying hypercapnia, hypoventilation at the earliest in the recovery area, thus preventing serious complications.

Akshatha Kamath

Joel Yarmush

Sneha Rao

Left Lower Lung Collapse in a Patient Undergoing Endoscopic Procedure

A 4-year-old child had closure of tracheocutaneous fistula under general anaesthesia. He developed extensive surgical emphysema over the face, chest, and upper abdomen immediately in the recovery room. We gave him oxygen supplementation, removed surgical stitch, and inserted a 4&#x2009;mm tracheostomy tube to secure airway. Chest X-ray ruled out pneumothorax or pneumomediastinum. After a week, a tight bandage was applied which approximated the tissue and helped in the closure of stoma; no suture was applied. The patient was discharged home on the fourth postoperative day. The patient needs close observation in the postoperative period with likely complication in mind. Recognizing early signs and symptoms of respiratory distress with quick intervention is lifesaving during the complication of tracheocutaneous fistula surgery. In absence of pneumothorax or pneumomediastinum, extensive surgical emphysema occurring during primary closure of tracheocutaneous fistula can be treated without inserting any drainage tube.

R. Gurung

B. M. Shakya

H. Dutta

Extensive Surgical Emphysema in a Child after Primary Closure of Tracheocutaneous Fistula

Among patients who develop anaphylaxis during anesthesia, anaphylaxis caused by a neuromuscular blocking agent has the highest incidence. In patients who developed IgE-mediated anaphylaxis, and cross-reactivity among NMBAs is a concern in subsequent anesthetic procedures. We present a patient who developed rocuronium-induced anaphylaxis in whom the skin prick test (SPT) and intradermal test (IDT) could identify a safe drug to use in the subsequent anesthetic procedure. A 32-year-old female developed anaphylactic shock at the induction of general anesthesia. She recovered by administration of hydrocortisone and epinephrine. Skin tests including the SPT followed by the IDT revealed rocuronium as the drug that caused anaphylaxis and vecuronium as a safe drug to use for the subsequent general anesthesia. She safely underwent surgery with general anesthesia using vecuronium one month after the skin testing. There are not many reports on the effectiveness of the SPT followed by IDT in identifying the causative drug as well as a safe drug to use in the subsequent anesthetic procedure following anaphylaxis during anesthesia. The usefulness of the SPT should be re-evaluated.

Manzo Suzuki

Hajime Kawase

Azusa Ogita

Hiroyasu Bito

Skin Testing to Identify Safe Drugs for Patients with Rocuronium-Induced Anaphylaxis

When performing left-sided catheter ablation, anticoagulation is used to prevent formation of thrombi that might embolize. After heparin administration, appropriate anticoagulation is confirmed by measuring Activated Coagulation Time (ACT). We report a case during which ACT results were erroneous, and review alternatives to the ACT under such circumstances.

Sheldon Goldstein

Jazmin Juarez

Agathe Streiff

Erroneous Activated Coagulation Time During Atrial Flutter Ablation

About this journal

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 2020

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