• Challenge of a Difficult Airway and Anesthetic Management in a Patient with Still's Disease

      Donald, Ranita R.; Taylor, Emi; Gallen, Thomas; Department of Anesthesiology and Perioperative Medicine (American Society of Anesthesiologists, 2010-10)
      Adult-onset Still’s disease (AOSD) is a rare systemic inflammatory disorder of unknown etiology with articular and extra-articular (systemic) manifestations. The disorder owes its name to Sir George Frederick Still, who in 1897 described 22 children with symptoms consistent with what is currently known as systemic onset juvenile idiopathic arthritis. AOSD was established almost a century later in 1971, when Eric Bywaters encountered and described adult patients presenting with pediatric Still’s disease symptoms. Compared to rheumatoid arthritis in adults, AOSD runs a much more acute course, quite often affecting many parts of the body before settling in the various joints. Diagnosis of AOSD is difficult to establish due to the nonspecific clinical and laboratory findings. Tracheal intubation may become difficult due to impairment of cervical spine, temporomandibular joint and laryngeal involvement (crico-arytenoid arthritis). Patients with chronic articular disease have more disability and worse prognosis than patients with only systemic symptoms.
    • Drug-eluting Stent Thrombosis and Acute Myocardial Infarction in PACU

      Donald, Ranita R.; Issah, Seidu; Chaknis, Caren; Department of Anesthesiology and Perioperative Medicine (American Society of Anesthesiologists, 2009-10)
      Lately, more patients have been presenting for noncardiac surgery after recent placement of cardiac stents, either bare-metal stents or drug-eluting stents. Noncardiac surgery performed following recent stent placement poses risk of acute stent thrombosis due to inherent hypercoagulable state of surgery as well as the common practice of perioperatively discontinuing antiplatelet therapy, which may result in major adverse cardiac events such as stent thrombosis, myocardial infarction and death. Acute stent thrombosis accounts for up to a 60% acute myocardial infarction rate and up to a 45% mortality rate. The risk of perioperative bleeding associated with continued antiplatelet therapy must be weighed against the catastrophic event of stent thrombosis. We report a challenging case involving DES thrombosis and acute myocardial infarction in the immediate postoperative period. This case highlights the importance of the scientific advisory recently released by the American Heart Association and American College of Cardiology against the premature discontinuation of antiplatelet therapy in patients with coronary stents.
    • 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.
    • Strategies for a Successful Anesthesiology Clerkship and Rewarding Experience for Medical Students

      Donald, Ranita R.; Odo, Nadine; Dawkins, Susan; Mason, Nikova; Gilbertson, Laura; Department of Anesthesiology and Perioperative Medicine (American Society of Anesthesiologists, 2010-10)
      The anesthesiology clerkship is a senior year selective in our institution which fulfills the critical care rotation requirement. Our clerkship has been such a popular rotation that enrollment can be quite competitive. Thanks to the dedication of our faculty and residents, students consistently report positive experiences about this rotation. Many of the medical students are not aware of the anesthesiologist’s multi- faceted role as a perioperative physician until their clerkship rotation in anesthesiology. Choosing a specialty is a difficult and stressful process. Anesthesiology continues to be a highly desirable specialty among U.S. medical students.