• TEE to facilitate anesthetic management during thoracotamy in a patient with severe pulmonary hypertension and pulmonary venous obstruction

      Aryal, Anuj; Mehta, Anand; Arthur, Mary E.; Castresana, Manuel R.; Medical College of Georgia; Department of Anesthesiology and Perioperative Medicine (American Society of Anesthesiologists, 2009-10)
      The lateral decubitus position, use of one-lung ventilation, and the prevention and treatment of hypoxemia continue to present challenges to the anesthesiologist, particularly in the patient with pulmonary hypertension. We describe the utility of intraoperative transesophageal echocardiography in the management of a patient with severe pulmonary hypertension and pulmonary vein stenosis undergoing thoracotomy for tissue diagnosis.
    • Thrombolytic Therapy in a Patient with an Epidural Catheter

      Janardhanam, Ram; Mellinger, John D.; Hammonds, William D; Department of Anesthesiology and Perioperative Medicine (American Society of Anesthesiologists, 2010-10)
      The ability to provide comfort and relieve pain during the postoperative period is a priority in the care of the surgical patient. Epidural anesthesia is widely used to manage postoperative pain. The epidural infusion of local anesthetics combined with opioids provides excellent pain relief. It also reduces intra- and postoperative narcotic requirements, leading to earlier mobilization and faster discharge. However, epidural analgesia carries risks for the patient. This presentation reports on the risk of treating a patient with thrombolytics while receiving epidural analgesia.
    • Transcranial Doppler measures in patients with sickle cell disease at high risk for stroke and receiving hydroxyurea: the HyRetro ancillary study

      Adamkiewicz, Thomas; Odo, Nadine; Kutlar, Abdullah; Kwiatkowski, Janet L; Adams, Robert J; School of Medicine; Morehouse College; Department of Anesthesiology and Perioperative Medicine (American Society of Hematology, 2010-12)
      Children with sickle cell disease (SCD) and increased transcranial Doppler sonography velocity measures are at increased risk for stroke. Although chronic transfusion decreases risk tenfold, this form of therapy is burdensome and includes risk of iron overload. Hydroxyurea therapy is effective in preventing SCD complications, although its effect in preventing SCD central nervous system complications is less clear and a matter of current investigation.
    • Unanticipated Acute Adrenal Insufficiency During Emergency Thoracotomy Re-Exploration

      Rawlings, J Lee; Spivey, Jerry A; Castresana, Manuel R.; Department of Anesthesiology and Perioperative Medicine (American Society of Anesthesiologists, 2010-10)
      For the last 50 years there has been a debate over the management of corticosteroid supplementation in the context of surgical or critically ill patients. At a minimum, clinicians agree that chronic corticosteroids should be continued in the perioperative or ICU setting, however in patients without a history of steroid use, acute adrenal insufficiency as the cause of hemodynamic compromise can be an elusive diagnosis. We present a case report.
    • Use of Dexmedetomidine as Adjuvant for the Anesthetic Management of Obese Children with Obstructive Sleep Apnea Undergoing Tonsillectomy and Adenoidectomy

      Mendiola, Raul A.; Florentino-Pineda, Ivan; Department of Anesthesiology and Perioperative Medicine (Society for Pediatric Anesthesia, 2009-03)
      Obstructive sleep apnea (OSA) in children is most commonly associated with tonsillar and adenoid hypertrophy. Use of opioids and residual amounts of inhaled agents can cause severe respiratory depression and thus represent an added risk to patients with OSA in the immediate postoperative period. Dexmedetomidine, a specific alpha 2-adrenergic receptor agonist, is known for its hypnotic, sedative, analgesic and sympatholytic properties. It potentiates analgesia with the advantages of minimal respiratory compromise, rapid onset and clearance. Because dexmedetomidine has been shown to be effective as an analgesic and sedative agent while minimizing respiratory compromise, it offers a safer alternative as an adjuvant for the anesthetic management of obese pediatric patients with OSA undergoing tonsillectomy and adenoidectomy.
    • 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.
    • Use of the Video RIFL (Rigid Flexible Laryngoscope) as an Adjunct to Direct Laryngoscopy

      Setty, Harsha; Gallen, Thomas; Dubin, Stevin; Department of Anesthesiology and Perioperative Medicine (Society for Airway Management, 2010-09)
      The ASA difficult airway algorithm incorporates different modalities in its progression. It is not uncommon for the user to fail at direct laryngoscopy, thus requiring an alternate method for securing an airway. Frequently, the alternate modalities include supraglottic airways, rigid videolaryngoscopes, or flexible fiberoptic bronchoscopes. We retrospectively reviewed charts from February 2009 to February 2010 on patients intubated in the operating room using the Video RIFL.