Anesthesia for pericardial window in a pregnant patient with cardiac tamponade and mediastinal mass

Cardiac tamponade during pregnancy due to primary lung cancer: A case report

We report a rare case of cardiac tamponade caused by lung cancer in a pregnant woman. A 32-year-old multiparous pregnant woman was admitted to the hospital at 15 weeks of gestation with a persistent cough and dyspnea. Transthoracic echocardiography revealed a pericardial effusion with evidence of tamponade physiology. Computed tomography (CT) revealed a massive pericardial effusion and a left lung tumor. Pericardial tamponade was successfully treated using pericardiocentesis. She was diagnosed with lung adenocarcinoma stage IVB based on bronchoscopic lung biopsy, which showed adenocarcinoma and CT, which showed brain metastasis. Pregnancy was terminated at 18 weeks of gestation, followed by molecular-targeted therapy with alectinib hydrochloride and whole-brain irradiation. 24 months after treatment initiation the patient is alive without disease progression. Although pericardial tamponade caused by a malignant tumor during pregnancy is a rare and serious life-threatening condition, appropriate diagnosis and prompt treatment can improve maternal prognosis.

High-Risk Airway Management in the Emergency Department: Diseases and Approaches, Part II

BACKGROUND

Successful airway management is critical to the practice of emergency medicine. Thus, emergency physicians must be ready to optimize and prepare for airway management in critically ill patients with a wide range of physiologic challenges. Challenges in airway management commonly encountered in the emergency department are discussed using a pearl and pitfall discussion in this second part of a 2-part series.

OBJECTIVE

This narrative review presents an evidence-based approach to airway and patient management during endotracheal intubation in challenging cases commonly encountered in the emergency department.

DISCUSSION

Adverse events during emergent airway management are common with postintubation cardiac arrest, reported in as many as 1 in 25 intubations. Many of these adverse events can be avoided by proper identification and understanding the underlying physiology, preparation, and postintubation management. Those with high-risk features including trauma, elevated intracranial pressure, upper gastrointestinal bleed, cardiac tamponade, aortic stenosis, morbid obesity, and pregnancy must be managed with airway expertise.

CONCLUSIONS

This narrative review discusses the pearls and pitfalls of commonly encountered physiologic high-risk intubations with a focus on the emergency clinician.

Ketamine applications beyond anesthesia - A literature review

Ketamine's clinical use began in the 1970s. Physicians benefited from its safety and ability to induce short-term anesthesia and analgesia. The psychodysleptic effects caused by the drug called its further clinical use into question. Despite these unpleasant effects, ketamine is still applied in veterinary medicine, field medicine, and specialist anesthesia. Recent intensive research brought into light new possible applications of this drug. It began to be used in acute, chronic and cancer pain management. Most interesting reports come from research on the antidepressive and antisuicidal properties of ketamine giving hope for the creation of an effective treatment for major depressive disorder. Other reports highlight the possible use of ketamine in treating addiction, asthma and preventing cancer growth. Besides clinical use, the drug is also applied to in animal model of schizophrenia. It seems that nowadays, with numerous possible applications, the use of ketamine has returned; to its former glory. Nevertheless, the drug must be used with caution because still the mechanisms by which it executes its functions and long-term effects of its use are not fully known. This review aims to discuss the well-known and new promising applications of ketamine.

Cardiac tamponade in a woman with preeclampsia

Background: Preeclampsia is associated with alterations in maternal vascular permeability and can thus cause intravascular volume depletion and pathologic extravascular fluid accumulation. Although typically manifesting as peripheral edema or, in more severe cases, non-cardiogenic pulmonary edema, preeclampsia-associated vascular abnormalities can theoretically cause abnormal fluid collection in any extravascular space, including the pericardium.

Case: We report the case of a 30-year-old gravida 1 female admitted at 31 weeks 4 days’ gestation with mild preeclampsia, tachycardia, and dyspnea, whose initial workup was only significant for a small pericardial effusion. Over the course of the next 4 weeks, however, the effusion evolved into early cardiac tamponade that required expeditious pericardiotomy and cesarean delivery. The effusion virtually resolved over the first month postpartum.

Conclusion: The case describes a unique presentation of preeclampsia and suggests that echocardiography to evaluate for pericardial effusion be considered in cases of otherwise-unexplained cardiopulmonary symptoms in the setting of preeclampsia. If detected, cardiac tamponade should be managed in association with a multidisciplinary team familiar with the physiology of cardiac tamponade.

The intraoperative management of patients with pericardial tamponade

The anesthetic management of patients with pericardial tamponade is challenging, as they present with not only the cardiovascular compromise that defines pericardial tamponade, but often have comorbid conditions that increase the complexity of their management. This review describes the pathophysiology, etiology, clinical presentation, and anesthetic management of patients with pericardial tamponade, with an emphasis on the intraoperative period and the management of pericardial window procedures, the most common clinical scenario where anesthesiologists will encounter pericardial tamponade.

Prehospital mechanical ventilation of a critical cardiac tamponade

Mechanical ventilation of a critical cardiac tamponade is a high-risk situation that can lead to asystolic cardiac arrest. We report a prehospital mechanical ventilation of a penetrating cardiac injury complicated with tamponade. Onset diagnosis of the circulatory arrest allowed by prehospital continuous ultrasonography led to earlier initiation of the resuscitation and might have favored successful outcome. Electrocardiographic signs are too late to diagnose circulatory arrest.

Anaesthesia for caesarean section in a woman with lung cancer: case report and review

A 33-year-old woman pregnant with twins was diagnosed with metastatic lung cancer during pregnancy. Her multidisciplinary care raised many medical and ethical issues. To help decide on the best anaesthetic technique for caesarean section, a literature search of published case reports of pregnancy associated with lung cancer was performed. Thirty-five cases of primary lung cancer associated with pregnancy were found. Anaesthetic technique was reported in only five of the 20 patients who underwent caesarean section: one spinal, three epidurals and one general anaesthetic. Of the 11 patients who delivered vaginally, only one was reported to have received epidural analgesia. As published data regarding anaesthesia and analgesia are limited for women with lung cancer in pregnancy, we describe our perioperative approach and review the potential challenging aspects of management in a pregnant patient with metastatic lung cancer.