• Intranasal Septal Perforation in a 4-Year-Old by an Impacted Button Battery: A Case Report and Review of the Literature

      Mattingly, Diana; Crews, Lindsay K; Florentino-Pineda, Ivan; Department of Anesthesiology and Perioperative Medicine (Society for Pediatric Anesthesia, 2010-03)
      While intranasal foreign bodies account for less than 1% of pediatric emergency room visits, proper diagnosis and management is critical to minimize significant morbidity and mortality. Intranasal button batteries in particular pose a significant threat to the pediatric population as nasal mucosal necrosis, septal perforation, facial cellulitis, and lateral nasal wall necrosis can occur within hours of insertion. The incidence of impacted button batteries has risen with the increased prevalence in common electronics like hearing aids, watches, and musical greeting cards. One study estimated that button batteries comprised 7% of intranasal foreign bodies removed from pediatric patients in a 6-month period. We report a case of intranasal button battery impaction in a 4-year-old male that resulted in significant tissue injury and required general anesthesia for extraction.
    • Morbidly Obese Complex Obstetrical Patient with Undiagnosed Peripartum Cardiomyopathy and Development of Flash Pulmonary Edema in PACU

      Donald, Ranita R.; Crews, Lindsay K; Department of Anesthesiology and Perioperative Medicine (International Anesthesia Research Society, 2010-05)
      Peripartum cardiomyopathy (PPCM) is a rare disorder of uncertain etiology. Virchow and Porack first recognized the relationship between heart failure and pregnancy in the 1870s when they noted myocardial degeneration in patients who died in the postpartum period. PPCM was first described as a distinctive cardiomyopathy in 1937 by Gouley et al. Since then, much has been learned about this disease process, and better treatment options now exist. Incidence varies greatly worldwide. Reports suggest an incidence of 1 case per 299 live births in Haiti, 1 per 1000 in South Africa, and 1 per 3000-4000 in the United States. Reported mortality rates are between 18% and 56%. A latent form of PPCM has also been described. Here we describe a case of latent PPCM in a morbidly obese patient who developed dramatic flash pulmonary edema in the postanesthesia care unit.
    • The Use of Dexmedetomidine During Nasotracheal Intubation in a Patient with CHARGE Syndrome

      Crews, Lindsay K; Mattingly, Diana; Florentino-Pineda, Ivan; Department of Anesthesiology and Perioperative Medicine (Society for Pediatric Anesthesia, 2010-03)
      CHARGE Syndrome (CS), also known as Hall-Hittner syndrome, is a congenital disorder comprised of multiple anomalies (coloboma, heart defect, atresia choanal, retarded growth and development, genital hypoplasia, ear anomalies/deafness). First described in 1979 by Hall and Hittner, it is caused by a mutation in the gene CHD7 on chromosome 8.1 Facial and upper airway features of CS, including midface hypoplasia, micrognathia, cleft lip, and palate, anterior larynx, and subglottic stenosis, make the airway management of these patients a challenge for the anesthesiologist. Because difficult airway management is a concern, spontaneous ventilation is recommended until the airway is secured. We report the use of dexmedetomidine (DEX) for deep sedation in a CS patient who required nasotracheal intubation using a fiberoptic bronchoscope (FB) while breathing spontaneously.