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Cao H, Jiang M, Zhuang Z, Wang S, Cao Q. Case report: Successful anesthesia management of noncardiac surgery in a patient with single atrium. Front Pharmacol 2024; 15:1370263. [PMID: 38756372 PMCID: PMC11097672 DOI: 10.3389/fphar.2024.1370263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 04/02/2024] [Indexed: 05/18/2024] Open
Abstract
Background Single atrium is very rare congenital cardiac anomaly in adults. The prognosis of patients with single atrium is very poor, with 50% of patients dying owing to cardiopulmonary complications in childhood. Herein, we focused on anesthesia management for noncardiac surgery in patients with single atrium. Case presentation A 58-year-old male with a history of bilateral varicocele underwent laparotomy for high-position ligation of the spermatic vein. The patient also had a history of single atrium, atrial fibrillation, chronic heart failure, pulmonary hypertension (PH), and complete right bundle branch block (CRBBB). Given the significant complications associated with general anesthesia in patients with PH, we preferred to use low-dose epidural anesthesia for this patient. Transthoracic echocardiography was used to assess cardiac function before and during surgery and guide perioperative fluid therapy. To limit the stress response, we used a regional nerve block for reducing postoperative pain. Furthermore, we used norepinephrine to appropriately increase the systemic vascular resistance in response to the reduction of systemic vascular resistance caused by epidural anesthesia. Conclusion Low-dose epidural anesthesia can be safely used in patients with single atrium and PH. The use of perioperative transthoracic echocardiography is helpful in guiding fluid therapy and effectively assessing the cardiac structure and function of patients. Prophylactic administration of norepinephrine before epidural injection may make it easier to maintain the patient's BP.
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Affiliation(s)
- Hong Cao
- Department of Anesthesia and Perioperative Medicine, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Hospital), Qingdao, Shandong, China
| | - Mengmeng Jiang
- Department of General Medicine, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Hospital), Qingdao, Shandong, China
| | - Zhao Zhuang
- Department of Anesthesia and Perioperative Medicine, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Hospital), Qingdao, Shandong, China
| | - Shoushi Wang
- Department of Anesthesia and Perioperative Medicine, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Hospital), Qingdao, Shandong, China
| | - Qianqian Cao
- Department of Anesthesia and Perioperative Medicine, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Hospital), Qingdao, Shandong, China
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Duarte SS, Nguyen TAT, Koch C, Williams K, Murphy JD. Remote Obstetric Anesthesia: Leveraging Telemedicine to Improve Fetal and Maternal Outcomes. Telemed J E Health 2019; 26:967-972. [PMID: 31710285 DOI: 10.1089/tmj.2019.0174] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
In the United States, the prevalence of pregnancy-related deaths has risen significantly over the past 20 years. Pregnant women at high risk for peripartum complications should undergo anesthesia consultation before delivery so that a management plan can be created between the obstetrician, anesthesiologist, and patient to ensure optimal outcomes for both the mother and newborn. However, few hospitals outside of major, urban, academic medical centers have dedicated anesthesiologists specially trained in obstetric anesthesia and the resources available to expedite optimization of high-risk parturient comorbidities. Telemedicine is a valuable tool by which evaluation, triaging, and multidisciplinary coordination can be provided for high-risk obstetric patients living in remote or rural communities without access to specialized, maternal care medical facilities. This review examines the existing literature regarding telemedicine use in preoperative anesthesia and antenatal obstetrics and identifies areas for future research. Furthermore, the benefits and potential barriers of implementing a telemedicine program specifically dedicated to obstetric anesthesia are discussed.
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Affiliation(s)
- Shirley S Duarte
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Truc-Anh T Nguyen
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Colleen Koch
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Kayode Williams
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
| | - Jamie D Murphy
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA
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Ramos JA, Shettar SS, James CF. Neuraxial analgesia in a parturient with the VACTERL association undergoing labor and vaginal delivery. BRAZILIAN JOURNAL OF ANESTHESIOLOGY (ENGLISH EDITION) 2018. [PMID: 28081906 PMCID: PMC9391690 DOI: 10.1016/j.bjane.2016.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Introduction The term VACTERL is an acronym for an association of congenital malformations: including vertebral, anal, cardiac, tracheo-esophageal, renal and limb anomalies. VACTERL anomalies pose a formidable challenge to anesthesiologists. We describe the anesthetic management of a parturient with VACTERL association, who underwent neuraxial analgesia for labor and vaginal delivery. Case report A 23 year old primigravida at 39 weeks gestation presented in labor at 4 cm cervical dilatation, completely effaced, requesting labor analgesia. Past medical history included VACTERL association with an imperforate anus and a partial endocardial cushion defect, both repaired in early childhood. She also had significant dorso-lumbar scoliosis with an extra lumbar vertebra. An MRI performed at 14 years age revealed the above findings with no spinal cord abnormalities. With a normal neurologic exam, a combined spinal epidural technique was performed. Despite significant scoliosis, the epidural space was identified at approximately the L3–L4 interspace at a depth of 5 cm. Spinal Fentanyl 25 mcg was administered followed by continuous patient-controlled epidural analgesia. The patient experienced excellent pain relief throughout her labor, and had an uneventful vaginal delivery 5 h after epidural placement. Discussion The rarity of VACTERL association in the obstetric population with its extensive anomalies mandates a multidisciplinary approach in the prenatal period as it can pose major challenges to all health care providers, including airway, ventilatory, cardiac and neuraxial problems. This is the first reported case of a successful and safe neuraxial technique in a laboring patient with the VACTERL association with albeit limited vertebral and spinal cord anomalies.
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Affiliation(s)
- Juan A Ramos
- Department of Anesthesiology, University of Florida Health, Gainesville, Florida, EUA.
| | - Shashank S Shettar
- Department of Anesthesiology, University of Florida Health-Jacksonville, Jacksonville, Florida, EUA
| | - Christopher F James
- Department of Anesthesiology, University of Florida Health, Gainesville, Florida, EUA; Department of Anesthesiology, Mayo Clinic, Jacksonville, Florida, EUA
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Han Y, Zhang Z, Sun Q, Ding K, Han L, Dong M, Xu Y, Ge L. Combined spinal-epidural anesthesia for cesarean delivery in a patient with cor triloculare biventriculare. BMC Anesthesiol 2017; 17:115. [PMID: 28851292 PMCID: PMC5576131 DOI: 10.1186/s12871-017-0411-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 08/25/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cor triloculare biventriculare accounts for approximately 0.31% of cases of congenital heart disease (CHD). Moreover, people with cor triloculare biventriculare always have shorter life spans, and cases of gestation are rare. There have been various related reports of cor triloculare biventriculare in recent years. CASE PRESENTATION We described an emergency cesarean section of a 30-year-old, 38-weeks-pregnant woman suffering from cardiac insufficiency and fetal distress. Combined spinal-epidural anesthesia was performed safely, and a male baby was smoothly delivered 10 min after the procedure without any adverse outcome on the mother or newborn. After surgery, we advised that the patient submit to an echocardiogram examination, which revealed the congenital heart disease cor triloculare biventriculare. CONCLUSIONS Combined spinal-epidural anesthesia was administered to a patient with cor triloculare biventricularethis with good effect, ensuring the patient's safety and meeting the need for emergency surgery.
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Affiliation(s)
- Yuan Han
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, NO. 99 Huaihai Road, Quanshan District, Xuzhou city, Jiangsu Province, China.,Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou, 221002, China
| | - Zhenfeng Zhang
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou, 221002, China
| | - Qingchun Sun
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou, 221002, China
| | - Ke Ding
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou, 221002, China
| | - Liu Han
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou, 221002, China
| | - Mengmeng Dong
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou, 221002, China
| | - Yifan Xu
- Jiangsu Province Key Laboratory of Anesthesiology, Xuzhou, 221002, China
| | - Lei Ge
- Department of Anesthesiology, The Affiliated Hospital of Xuzhou Medical University, NO. 99 Huaihai Road, Quanshan District, Xuzhou city, Jiangsu Province, China.
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[Neuraxial analgesia in a parturient with the VACTERL association undergoing labor and vaginal delivery]. Rev Bras Anestesiol 2017; 68:205-208. [PMID: 28081906 DOI: 10.1016/j.bjan.2016.05.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 05/25/2016] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION The term VACTERL is an acronym for an association of congenital malformations: including vertebral, anal, cardiac, tracheo-esophageal, renal and limb anomalies. VACTERL anomalies pose a formidable challenge to anesthesiologists. We describe the anesthetic management of a parturient with VACTERL association, who underwent neuraxial analgesia for labor and vaginal delivery. CASE REPORT A 23 year old primigravida at 39 weeks gestation presented in labor at 4cm cervical dilatation, completely effaced, requesting labor analgesia. Past medical history included VACTERL association with an imperforate anus and a partial endocardial cushion defect, both repaired in early childhood. She also had significant dorso-lumbar scoliosis with an extra lumbar vertebra. An MRI performed at 14 years age revealed the above findings with no spinal cord abnormalities. With a normal neurologic exam, a combined spinal epidural technique was performed. Despite significant scoliosis, the epidural space was identified at approximately the L3-L4 interspace at a depth of 5cm. Spinal Fentanyl 25mcg was administered followed by continuous patient-controlled epidural analgesia. The patient experienced excellent pain relief throughout her labor, and had an uneventful vaginal delivery 5h after epidural placement. DISCUSSION The rarity of VACTERL association in the obstetric population with its extensive anomalies mandates a multidisciplinary approach in the prenatal period as it can pose major challenges to all health care providers, including airway, ventilatory, cardiac and neuraxial problems. This is the first reported case of a successful and safe neuraxial technique in a laboring patient with the VACTERL association with albeit limited vertebral and spinal cord anomalies.
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Moaveni DM, Cohn JH, Zahid ZD, Ranasinghe JS. Obstetric Anesthesiologists as Perioperative Physicians: Improving Peripartum Care and Patient Safety. CURRENT ANESTHESIOLOGY REPORTS 2015. [DOI: 10.1007/s40140-014-0094-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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