A Parturient With Fontan Physiology and Suspected Placenta Accreta Spectrum: A Case Report

Cureus · 2025-10-13

This manuscript reviews a complex case of a gravida 3, para 2 (G3P2) parturient with Fontan physiology, complicated by suspected placenta accreta spectrum (PAS) versus massive subchorionic thrombohematoma (MST), presenting with placental abruption at 32 weeks of gestation. This case highlights the intricacies of managing pregnancy in patients with single ventricle physiology, underscoring the necessity for comprehensive, coordinated care across specialties to optimize maternal and fetal outcomes.

Fatal Complications During Photodynamic Bone Stabilization: A Case Report

Cureus · 2025-07-24

Photodynamic bone stabilization (PBSS) is a minimally invasive technique used in patients with metastatic bone disease who are poor traditional surgery candidates. Although the procedure has a high success rate, we present a fatal case of cardiopulmonary collapse following balloon insufflation during PBSS. The patient had advanced malignancy and preexisting cardiopulmonary conditions and ultimately experienced pulseless electrical activity and hypoxemia. We propose that the likely etiology is embolic debris from medullary reaming. This case highlights the need for perioperative risk stratification, vigilant intraoperative monitoring, and heightened awareness of fatal embolic complications in high-risk patients undergoing PBSS.

Management of High Spinal Anesthesia for Cesarean Section in the Semi-Fowler's Position

Cureus · 2025-09-26

High spinal anesthesia, a rare but serious complication of neuraxial techniques, occurs when local anesthetic spreads through the cerebrospinal fluid, blocking spinal segments above the intended level. This can lead to significant cardiovascular, respiratory, and neurological effects. These effects include vasodilation, bradycardia, and potential respiratory failure if the phrenic nerve or brainstem is affected. High spinal blocks are particularly concerning in obstetric anesthesia, where they are used for labor analgesia and cesarean deliveries. The ability to quickly and effectively manage this high-risk event can significantly reduce the risk of maternal and fetal morbidity and mortality. In the event of a high spinal, we describe how the use of a semi-Fowler's position can salvage a high spinal and even prevent the need for intubation.

Pediatric malignant hyperthermia: recognizing early warning signs – a case report

Anaesthesia Pain & Intensive Care · 2025-07-17 · 1 citations

Malignant hyperthermia (MH) is a rare, life-threatening pharmacogenetic disorder triggered by exposure to volatile anesthetics and succinylcholine. It results from mutations in the RYR1 gene, leading to excessive intracellular calcium release, hypermetabolism, and potential multiorgan dysfunction. Prompt recognition and treatment are essential to reduce morbidity and mortality. We report the case of an 11-year-old female undergoing pancreaticoduodenectomy who developed intraoperative MH following sevoflurane exposure. Early signs included rising end-tidal CO₂ (EtCO₂) despite increased ventilation, followed by tachycardia and metabolic acidosis, with a peak temperature of 37.1°C. MH was suspected approximately two hours after induction, leading to immediate discontinuation of sevoflurane, transition to total intravenous anesthesia, and administration dantrolene. The patient's vital signs stabilized, and the surgery was completed without further complications. This case underscores the importance of early MH recognition, especially in pediatric patients, who may present with subtle or atypical symptoms. The MH Clinical Grading Score, designed for adults, may not reliably predict MH likelihood in children, necessitating a high index of suspicion. Given the variable presentation of MH in pediatric patients, anesthesiologists must be vigilant in monitoring intraoperative changes. Timely intervention and adherence to MH crisis protocols significantly improve outcomes. Further research is needed to optimize pediatric-specific MH diagnostic criteria and management strategies. Abbreviations: MH: Malignant Hyperthermia, EtCO2: End Tidal Carbon Dioxide, RYR1: Ryanodine Receptor Gene Keywords: Malignant Hyperthermia; Anesthesia; Pediatric Anesthesia; General Anesthesia; Dantrolene; RYR1 gene Citation: Shah S, Dhoon T, Choi Y, Wang G, Rajan G. Pediatric malignant hyperthermia: recognizing early warning signs – a case report. Anaesth. pain intensive care 2025;29(4):446-452. DOI: 10.35975/apic.v29i4.2835 Received: May 09, 2024; Revised: October 26, 2024; Accepted: January 01, 2025

Managing Recurrent Carbon Dioxide Embolism During Laparoscopic Hepatectomy With Transesophageal Echocardiography Guidance: A Case Report

A&A Practice · 2025-01-01

Carbon dioxide gas emboli is a potentially fatal complication that occurs more frequently during laparoscopic hepatectomy compared to other laparoscopic surgeries. The patient featured in this report had massive gas embolism confirmed by intraoperative transesophageal echocardiography (TEE) that were associated with episodes of severe hypoxemia, hemodynamic instability, and right ventricular failure requiring conversion to open hepatectomy. Abrupt abdominal decompression resulted in massive hemorrhage from a previously undetected defect in the middle hepatic vein. The report demonstrates the successful management of gas embolism during laparoscopic hepatectomy even with a significant delay in vascular repair and highlights the critical role of TEE.

Retrograde Flow of Fluid Through the Nasolacrimal Duct System Under General Anesthesia: A Case Report

A&A Practice · 2024-02-29

This case report describes a rare incident of fluid exhibiting retrograde flow from the nasopharynx through the nasolacrimal duct and accumulating within the eye guard while under general anesthesia. The patient was in a steep Trendelenburg position for several hours and received multiple liters of intravenous fluid. The patient did not have a history of sinusitis, sinus surgery, cocaine use, dacryostenosis and dacryocystitis, or nasolacrimal duct irrigation and probing. This case provides insight into the potential ophthalmic implications of surgical and anesthetic management. While the patient fortunately had no complications, this case also underscores the importance of intraoperative vigilance.

Understanding the Physiological Connection: Cardiac Arrest Following Prone Positioning

Cureus · 2024-06-24

Prone positioning of patients is a routine occurrence in procedural suites and operating rooms (ORs). However, the physiological changes that occur with prone positioning are frequently underappreciated by proceduralists, surgeons, and anesthesiologists. This may be related to a sense of the routine or a lack of familiarity with physiological changes that accompany the prone position. The prone position, while aiding visualization and cannulation of the ampulla of Vater during endoscopic retrograde cholangiopancreatography (ERCP), can induce physiological changes such as reduced preload, inferior vena cava filling, and cardiac output; it can also increase intrathoracic pressure and mediastinal compression. Anesthetic agents can further impact cardiopulmonary physiology, decreasing systemic vascular resistance and reducing cardiac contractility. In addition, the transition from negative to positive pressure ventilation following endotracheal intubation can increase pulmonary artery pressures and right ventricular (RV) strain. Therefore, caution is needed with patients who have RV dysfunction, pulmonary hypertension, or preload dependency, as they may not tolerate prone positioning. We describe a case in which a 73-year-old male patient scheduled for an ERCP suffered cardiac arrest after being transitioned to the prone position. The patient was repositioned in the supine position and resuscitated. The case was completed in the supine position.

An Unusual Presentation of an Amniotic Fluid Embolism: Fetal Bradycardia As the First Sign

Cureus · 2024

• Medicine
• Cardiology
• Obstetrics

Amniotic fluid embolism (AFE) is a potentially fatal maternal condition demanding awareness from obstetricians and anesthesiologists regarding its different manifestations. The typical presentation involves maternal respiratory distress, cardiovascular collapse, neurological changes, and coagulopathy followed by fetal distress. This unusual case study emphasizes that fetal compromise may precede maternal decompensation as the initial sign of AFE. Fetal distress is a known symptom of AFE and is typically seen due to cardiorespiratory issues that lead to reduced uteroplacental perfusion, resulting in fetal hypoxia. In the case presented, fetal bradycardia occurred before any visible maternal symptoms, suggesting that fetal distress could be induced by factors independent of the mother's cardiopulmonary status. A 34-year-old healthy G4P2012 at 41 weeks and 2 days gestation who was initially laboring on the floor was emergently taken to the operating room for a cesarean delivery due to fetal bradycardia. Around the time the fetus was delivered, the patient displayed seizure activity, followed by a complete loss of consciousness and cardiac arrest. The patient was intubated and underwent cardiopulmonary resuscitation and defibrillation, subsequently converting to a wide complex tachycardia. In the operating room, there was evidence of heavy vaginal bleeding, uterine atony, and a fulminant form of disseminated intravascular coagulopathy (DIC), which required aggressive management over the next four hours. After achieving hemodynamic stability, the patient was transferred to the surgical intensive care unit (SICU), extubated on day 3, and discharged home on day 8.

Massive thoracic aortic dissection in the subacute postpartum period in a patient with Marfan syndrome

Anaesthesia Pain & Intensive Care · 2024-10-08

Aortic dissection is a life-threatening condition that can result in rupture, massive hemorrhage, and death. Parturients with Marfan syndrome are at increased risk of aortic dissection due to connective tissue dysfunction and physiologic changes secondary to pregnancy. Aortic dissection typically manifests during the intrapartum period, rather than the postpartum course. This article discusses a case of a parturient with Marfan syndrome who suffered a massive thoracic aortic dissection in the subacute postpartum period after an uncomplicated vaginal delivery. Abbreviations: CT - computerized tomography; AD - Aortic dissection; MFS - Marfan syndrome; PPD - postpartum day; TEVAR - thoracic endovascular aortic repair; TTE - transthoracic echocardiogram; VAVD - vacuum assisted vaginal delivery; VD - vaginal delivery Keywords: Marfan Syndrome; Pregnancy; Aortic Dissection; Neuraxial Anesthesia Citation: Dhoon T, Crain NA, Rahimian R, Rajan GR. Massive thoracic aortic dissection in the subacute postpartum period in a patient with Marfan syndrome. Anaesth. pain intensive care 2024;28(5):964−968; DOI: 10.35975/apic.v28i5.2564 Received: May 09, 2024; Reviewed: August 15, 2024; Accepted: August 15, 2024

Video laryngoscopy: a double-edged sword

Anaesthesia Pain & Intensive Care · 2023 · 1 citations

• Computer Science
• Medicine
• Computer Science

Endotracheal intubation revolutionized anesthesia and allowed prolonged surgical procedures to be performed. It also made positive pressure ventilation possible in patients in respiratory insufficiency and being managed in intensive care units. But successful intubation required the development of laryngoscopes. A variety of blades were developed to be used in different sets of patients. A laryngoscope came to be known as a symbol of the specialty of anesthesiology. But it was not always safe, nor successful, necessitating more sophisticated instruments. Video laryngoscopes were introduced with a sigh of relief for the anesthesiologists in difficult airway cases. Many variations of video laryngoscopes with slight differences have been marketed. But cases of video laryngoscope related injuries have been reported. This paper gives an over-view of the possible mechanism and preventive measures.
 Abbreviations: DL - Direct laryngoscopy; ETT – Endotracheal intubation; IDL - indirect laryngoscopy; VL - Video laryngoscopy; 
 Key words: Airway management; Instrumentation; Intubation, endotracheal; Laryngoscope; Laryngoscopy
 Citation: Dhoon TQ, Wilson L, Rajan GRC. Video laryngoscopy: a double-edged sword. Anaesth. pain intensive care 2023;27(3):413−416; DOI: 10.35975/apic.v27i3.2219
 Received: March 30, 2023; Reviewed: April 11, 2023; Accepted: April 15, 2023