Perioperative implications of amyloidosis and amyloid cardiomyopathy: A review for anesthesiologists.

It is well recognized that amyloid protein can infiltrate many regions of the body. This can include the peripheral nerves, the liver, kidney, spleen, the gastrointestinal tract, and most importantly the myocardium. The amyloid proteins that cause cardiomyopathy may come from genetically altered liver genes (transthyretin amyloid, ATTR) or from the bone marrow with malignant plasma cells (light chain amyloid, AL) generating the aberrant protein.

Novel treatment of bronchopleural fistula in a lung transplant recipient with endobronchial sealant and endobronchial valve placement via robotic-assisted bronchoscopy.

Bronchopleural fistulas (BPFs) are a dreaded complication following pulmonary surgery. Endobronchial valves (EVs), with endobronchial sealant (ES), instilled with robotic bronchoscopy (RB), allow occlusion of BPF, avoiding surgery. The patient was a 71-year-old woman with a history of chronic obstructive pulmonary disease and bronchiectasis who underwent bilateral lung transplantation and wedge resection of the right middle lobe and left lingula.

Gastric emptying of "clear liquid drinks" assessed with gastric ultrasonography: a blinded, randomized pilot study.

Background: Protein-containing liquids may delay gastric emptying and increase risk of aspiration. Commercial whey protein nutritional drinks (WPNDs) are advertised as "clear liquid nutritional drinks" and can be mistaken for protein-free, carbohydrate-based clear liquids. We used gastric ultrasonography to compare gastric emptying of a protein-free, carbohydrate-based clear liquid with that of a WPND in healthy volunteers.

Ultrasound Assessment of Gastric Volume After Bariatric Surgery: A Case Report.

Gastric ultrasound is emerging as a tool that can be used to assess gastric content and volume in patients with an unknown fasting history. This information can impact the choice of anesthetic technique or the timing of surgery due to the presumed risk of aspiration. Currently, no data are available regarding the use of gastric ultrasound for patients who have had prior gastric operations, despite the increasing number of patients undergoing bariatric surgery.

Complications related to intraoperative transesophageal echocardiography in liver transplantation.

Purpose: Intraoperative transesophageal echocardiography (TEE) has commonly been used for evaluating cardiac function and monitoring hemodynamic parameters during complex surgical cases. Anesthesiologists may be dissuaded from using TEE in orthotopic liver transplantation (OLT) out of concern about rupture of esophageal varices. Complications associated with TEE in OLT were evaluated.

Real-time two-dimensional and three-dimensional echocardiographic imaging of the thoracic spinal cord: a possible new window into the central neuraxis.

Transesophageal echocardiography of the spine has been difficult to perform, and high-quality images have been difficult to obtain with earlier available technology. New capabilities in hardware and software reconstruction may allow more reliable clinical data to be obtained. We describe an initial successful attempt to image the adult spinal canal, its contents, and in situ instrumentation.

Transesophageal echocardiography for detection of propagating, massive emboli during prosthetic hip fracture surgery.

Fat embolus has been known to occur during major orthopedic surgery. In many cases, fat embolus syndrome is a postoperative complication of long bone orthopedic surgery, particularly femoral fractures occurring after trauma. Changes in intraoperative cardiopulmonary function have been reported in a subset of these patients, and they are associated with the degree of embolization occurring with manipulation or cementing of prostheses in the fractured femur.

Fat emboli in total knee arthroplasty: a prospective randomized study of computer-assisted navigation vs standard surgical technique.

A prospective exploratory study of fat emboli in patients undergoing total knee arthroplasty was performed in patients randomly assigned to surgery with computer-assisted navigation or standard technique. Transesophageal echocardiography of the right atrium was recorded for 5 consecutive 1-minute intervals after tourniquet deflation. Emboli were graded on a scale of 0 to 3 based on embolism size, amount of atrium filled, and duration of embolic shower, creating an overall score of 0 to 9.

Real-time three-dimensional ultrasound for continuous interscalene brachial plexus blockade.

Two-dimensional ultrasound guidance is used commonly for regional anesthetic techniques. This report describes the novel use of three-dimensional, ultrasound-guided, continuous interscalene regional analgesia, which was used in a 36-year-old woman undergoing left total elbow arthroplasty. Possible advantages of this novel technology over current two-dimensional methods include a larger area of available scan information that enables multiple planes of view without having to reposition the ultrasound probe, and three-dimensional visualization of local anesthetic deposition perineurally.

The anesthesia information management system for electronic documentation: what are we waiting for?

The anesthesia information management system (AIMS) will be part of the future of healthcare. An electronic medical records system or AIMS will provide clear and concise information and have the potential to integrate information across the entire hospital system, improve quality of care, reduce errors, decrease risks, and improve revenue capture. The practice of anesthesia requires a medical record system that can capture data in real time.

Real-time three-dimensional ultrasound for continuous popliteal blockade: a case report and image description.

Two-dimensional ultrasound guidance has been used as an adjunct for neural blockade. With the development of newer ultrasound technology, three-dimensional ultrasound imaging is now available and may offer improved visualization of anatomic structures and relationships. We describe the successful blockade of the popliteal nerve with three-dimensional ultrasound guidance and image description.

Persons with dementia who become lost in the community: a case study, current research, and recommendations.

Providing care for persons with dementia presents several serious challenges. Among these is the possibility that a person with dementia will become lost in the community and face the risk of injury or death. Caregivers often cite anxiety about this possibility as a reason for placing their loved ones in a professional-care setting.

Use of continuous paravertebral analgesia to facilitate neurologic assessment and enhance recovery after thoracoabdominal aortic aneurysm repair.

Unlabelled: Neurologic assessment after thoracic aortic aneurysm repair is important for detecting and treating late onset paraplegia. Traditional methods of pain control, such as patient-controlled IV analgesia and epidural analgesia, may interfere with neurologic assessment. We present a case of a patient who received continuous thoracic paravertebral analgesia that provided excellent analgesia while preserving the ability to monitor neurologic function.

Continuous regional anesthesia before surgical peripheral sympathectomy in a patient with severe digital necrosis associated with Raynaud's phenomenon and scleroderma.

Background And Objective: Digital ischemia and necrosis caused by Raynaud's phenomenon in patients with connective tissue diseases may not respond to medical therapy and may have major adverse effects on quality of life. We describe the use of continuous ambulatory regional anesthesia for diagnosis and treatment before peripheral sympathectomy in a patient with secondary Raynaud's phenomenon.

Case Report: A 55-year-old man with progressive systemic sclerosis and secondary Raynaud's phenomenon presented with severe pain and digital necrosis that were refractory to maximal medical treatment and thoracic sympathectomy.