Balloon protection of the mesenteric-renal vessels during embolectomy of acute paravisceral aortic occlusion.

Acute thrombosis of the aorta is an uncommon, but potentially devastating, vascular emergency. The absence of pathognomonic signs or symptoms makes the diagnosis challenging and, often, time consuming. No optimal treatment has been established, with greater challenge present when the thrombus involves the mesenteric-renal vessels.

Postoperative opioid-induced respiratory depression or oversedation requiring naloxone treatment in a community hospital: a case series.

Background: Postoperative opioid-induced respiratory depression and oversedation can lead to fatal events and increase perioperative mortality. In reports from major academic centers, naloxone administration has been used as a proxy for severe opioid overdose. Herein, we studied the incidence, clinical characteristics, and outcomes of postoperative naloxone use in a mid-size community hospital.

Peripartum anesthetic management in patients with Ebstein anomaly: a case series.

Ebstein anomaly is a rare congenital cardiac condition associated with displacement and incompetence of the tricuspid valve. Peripartum anesthetic management can be particularly challenging since these patients are at high risk of cardiac failure and tachyarrhythmias. Risk stratification is important since it helps to identify high-risk patients who should deliver at a tertiary care center where a multidisciplinary team (obstetrics, cardiology, anesthesiology, and neonatology) is immediately available.

Spinal Anesthesia for Amyotrophic Lateral Sclerosis Patient Undergoing Lower Extremity Orthopedic Surgery: An Overview of the Anesthetic Considerations.

Background: Amyotrophic lateral sclerosis is a progressive neurodegenerative disease primarily affecting the upper and lower motor neurons. Patients present with a variety of clinical manifestations inevitably resulting in death secondary to respiratory insufficiency from muscle weakness and consequential pulmonary complications. Despite the lack of universal consensus on the ideal anesthetic approach to amyotrophic lateral sclerosis patients undergoing lower extremity total joint surgery, there are few noteworthy anesthetic considerations in this cohort.

Intraoperative Fluid Balance and Perioperative Outcomes After Aortic Valve Surgery.

Background: The effect of intraoperative fluid balance on postoperative acute kidney injury (AKI) in cardiac surgical patients is poorly defined.

Methods: In this retrospective study of patients undergoing aortic valve replacement for aortic stenosis, the primary outcome of interest was postoperative AKI. Secondary outcomes were postoperative fluid balance, cardiac index, vasopressor use, hospital-free days, stroke, myocardial infarction, hospital readmission, and 30- and 90-day mortality.

An Extremely Rare Cause of Mitral Regurgitation-Accessory Commissural Mitral Tissue with Anomalous Left Atrial Chordal Attachment.

• Accessory mitral tissue and left atrial chordae are rare congenital abnormalities. • Accessory mitral tissue can result in left ventricular outflow tract and mitral valve obstruction. • This is the first case of lateral mitral accessory tissue with an associate anomalous chord.

Intraoperative methadone administration and postoperative pain control: a systematic review and meta-analysis.

Postoperative pain is not adequately managed in greater than 40% of surgical patients and is a high priority for perioperative research. In this meta-analysis, we examined studies comparing postoperative opioid consumption and pain scores in surgical patients who received methadone by any route vs those who received another opioid by any route. Studies were identified from PubMed, Cochrane, Web of Science, EMBASE, and Scopus from January 1966 to November 2018.

Essential Thrombocythemia and Cardiac Surgery: A Case Series and Review of the Literature.

Background: Essential thrombocythemia (ET) is a rare myeloproliferative disorder characterized by an unexplained thrombocytosis (>450 × 10/L) and associated vasomotor, thrombotic, and hemorrhagic manifestations. Although the literature detailing the perioperative management of patients with ET undergoing cardiac operations is sparse, major perioperative complications have been reported, particularly in poorly controlled patients presenting with platelet counts of 800 × 10/L or higher. The purpose of this study was to provide the experience at a large tertiary medical center in managing patients with ET undergoing cardiac operation and to summarize the available literature.

Resection of Intrathoracic Paraganglioma With and Without Cardiopulmonary Bypass.

Background: Intrathoracic paragangliomas (PGLs) are rare tumors. Approximately 50% originate from and around cardiac structures.

Methods: A retrospective review was made of the perioperative course of patients with intrathoracic PGL resection from 2000 through 2015 at Mayo Clinic in Rochester, Minnesota.

Isoflurane and postoperative respiratory depression following laparoscopic surgery: A retrospective propensity-matched analysis.

Episodes of respiratory depression during the immediate postoperative recovery period (Phase I post-anesthesia recovery) have been associated with respiratory complications during Phase II recovery. Using multivariable analyses in several surgical cohorts, we previously identified potential associations between patient and perioperative factors and increased risk for Phase I respiratory depression. The aim of this study is to use the propensity-matched analysis to specifically assess for a potential association between the use of isoflurane and episodes of Phase I respiratory depression after laparoscopic operations.

Patients with glycogen storage diseases undergoing anesthesia: a case series.

Background: Glycogen storage diseases are rare genetic disorders of glycogen synthesis, degradation, or metabolism regulation. When these patients are subjected to anesthesia, perioperative complications can develop, including hypoglycemia, rhabdomyolysis, myoglobinuria, acute renal failure, and postoperative fatigue. The objective of this study was to describe the perioperative course of a cohort of patients with glycogen storage diseases.

History of carotid surgery: from ancient greeks to the modern era.

A relationship between decreased carotid arterial flow and apoplectic manifestations was already suspected by the ancient Greeks. Early attempts at carotid surgery, however, were limited to emergency arterial ligation in patients with neck trauma. Attempts to suture arterial stumps together to restore blood flow paved the way for Carrel's revolutionary idea of reconstructing the resected or injured arterial segment with an interposition vein graft.

Anesthesia and incident dementia: a population-based, nested, case-control study.

Objective: To test the hypothesis that exposure to procedures requiring general anesthesia during adulthood is not significantly associated with incident dementia using a retrospective, population-based, nested, case-control study design.

Participants And Methods: Using the Rochester Epidemiology Project and the Mayo Clinic Alzheimer's Disease Patient Registry, residents of Olmsted County, Minnesota, diagnosed as having dementia between January 1, 1985, and December 31, 1994, were identified. For each incident case, a sex- and age-matched control was randomly selected from the general pool of Olmsted County residents who were dementia free in the index year of dementia diagnosis.

Acute kidney injury following total joint arthroplasty: retrospective analysis.

Introduction: Postoperative acute kidney injury (AKI) following arthroplasty has not been well studied. Our aim was to identify factors associated with increased risk of AKI.

Methods: The medical records for adult patients who underwent elective total joint arthroplasty during June 1, 2007 to May 31, 2010 at the Mayo Clinic were reviewed to identify patients with normal preoperative kidney function who experienced perioperative AKI, defined as an increase in serum creatinine (sCr) by 26.

Acute kidney injury following bariatric surgery.

Background: Postoperative acute kidney injury (AKI) following bariatric surgery has not been well studied. The aim of this study is to identify factors associated with risk of AKI.

Methods: The medical records of adult patients who underwent bariatric surgery between March 1, 2005 and March 31, 2011 at the Mayo Clinic were reviewed to identify patients who experienced AKI, defined as postoperative increase in serum creatinine (sCr) by 0.

Kidney injury during pregnancy: associated comorbid conditions and outcomes.

Purpose: To investigate the characteristics of women who have kidney injury during pregnancy.

Methods: Medical records of all women who gave birth at our institution between January 1, 2005, and December 31, 2010, were retrospectively reviewed electronically. We identified those who incurred a kidney injury [defined by modified Acute Kidney Injury Network (AKIN) criteria: serum creatinine (sCr) increase ≥0.

Sirolimus in solid organ transplantation: current therapies and new frontiers.

Sirolimus (SRL) is a mammalian target of rapamycin inhibitor, which provides an immunosuppressive effect by inhibiting cell cycle progression. The encouraging results of combined SRL-cyclosporine therapy paved the way to further immunosuppressant combinations. Although SRL is relatively non-nephrotoxic when administered as monotherapy, it pharmacodynamically enhances the toxicity of calcineurin inhibitors.

Allergic reactions during anesthesia at a large United States referral center.

Background: The types of agents implicated to trigger intraoperative anaphylactic reactions vary among reports, and there are no recent series from the United States. In this retrospective study, we examined perioperative anaphylactic reactions that occurred at a major tertiary referral academic center.

Methods: To characterize perioperative allergens associated with anaphylactic reactions, we reviewed the Mayo Clinic Division of Allergic Diseases skin test database between 1992 to 2010.

Anesthetic considerations in mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome: a case series.

Purpose: Mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes syndrome (MELAS) is a rare inherited mitochondrial disorder associated with severe multiorgan pathology and stress-induced episodes of metabolic decompensation and lactic acidosis. The purpose of this case series is to review the medical records of patients with MELAS who underwent anesthetic care at the Mayo Clinic to observe their perioperative responses to anesthesia and to assess outcomes.

Principal Findings: From September 1997 to October 2010, nine patients with MELAS were identified who underwent 20 general anesthetics, 12 prior to MELAS diagnosis.

Perioperative course and intraoperative temperatures in patients with osteogenesis imperfecta.

Background And Objectives: Concerns persist regarding the association of osteogenesis imperfecta with perioperative complications and intraoperative hyperpyrexia. The purpose of this study is to examine whether osteogenesis imperfecta patients develop intraoperative hyperthermia and to describe anaesthesia-related complications.

Methods: Medical records of 49 osteogenesis imperfecta patients undergoing 180 anaesthetics were reviewed for the presence of perioperative anaesthetic complications.