Importance of Life-Long Alerts in Electronic Medical Report Systems for Patients With Positive Antigen Screening.

Perioperative red blood cell transfusions are common. Antigen screening, performed via indirect Coombs test, is required prior to red blood cell transfusion. False-negative test results can lead to acute or delayed hemolytic transfusion reactions. This case report emphasizes the importance of using life-long alerts in a hospital's electronic medical record system for patients with positive antigen screening to prevent false-negative preoperative antigen results from leading to hemolytic transfusion reactions.

Multiple Episodes of Severe Bronchospasm During General Anesthesia: A Case Report.

Bronchospasm is the clinical component of exacerbated underlying airway hyper-reactivity or as part of a more severe underlying pathology such as anaphylaxis. This article reports multiple episodes of bronchospasm after general anesthesia induction for elective surgery of laparoscopic cholecystectomy. Bronchospasm is a joint event during the intubation period, especially in patients with respiratory disease, but in most cases resolves without further complications. It was manifested in isolation in this patient, with no cardiovascular compromise, no skin signs. This case report reviews the literature and the algorithm taken to manage this adverse event and guarantees patient care and successful outcome.

Anesthetic Considerations in Patients With Achondroplasia.

Anesthetic management of achondroplastic patients warrants special anatomical and physiological considerations due to significant variations in the airway as well as the spine in regional techniques. In this report, we present the case of a 30-year-old morbidly obese male with achondroplasia, end-stage renal disease (ESRD) on hemodialysis, and renal osteodystrophy, who was scheduled for incision and drainage of a rectal abscess. Preoperative evaluation revealed Mallampati IV airway with a short neck and a scoliotic spine with possible atlantoaxial instability.

Intraoperative Blood Loss during Induced Abortion: A Comparison of Anesthetics.

OBJECTIVE: To determine whether there is a difference in intraoperative bleeding with inhalational versus noninhalational anesthetic agents for patients undergoing suction dilatation and curettage for first-trimester induced abortion. METHODS: This is an IRB-approved retrospective chart review of the electronic medical records of patients undergoing induced abortion at gestational ages between 5 0/7 and 14 0/7 weeks of pregnancy at the New York City Health + Hospitals/Metropolitan. The records of 138 patients who underwent suction dilatation and curettage for induced abortion between June 2012 and June 2014 were reviewed for an association between anesthetic technique and intraoperative hemorrhage. Twenty patients received inhalational anesthetic agents, while 118 received intravenous anesthetics. Blood loss was estimated by the operating gynecologists. RESULTS: The mean intraoperative blood loss for inhalational anesthetics (113.6 ml) was significantly higher than with noninhalational agents (40.2 ml) (p=0.007). Age, body mass index, and gestational age were not statistically different between the groups; the number of methylergonovine doses at induced abortion trended higher with inhalation anesthetics. CONCLUSIONS: The difference in blood loss between the two types of anesthetic techniques was statistically significant. These findings may be important for patients with significant anemia or at an increased risk of bleeding, such as those with unrecognized coagulopathies.

Increased risk of general anesthesia for high-risk patients undergoing magnetic resonance imaging.

OBJECTIVE: The aim of this study was to review mortality rate pertinent to anesthesia in magnetic resonance imaging (MRI) settings and compare it with operating room (OR) mortality rate. MATERIALS AND METHODS: A total of 47,389 anesthetics have been administered to pediatric patients in the Montefiore Medical Center between February 1998 and September 2007, of which 11,700 (25%) were administered for procedures performed outside the OR. Our data collection system allows us to separate outside OR locations into 2 separate groups. One group includes MRI, computed tomography scan, and radiology, and the other includes gastrointestinal procedures, hematology-oncology, and all others. The data we present show the total number of cases, and demographic numbers reflect the total numbers as well. RESULTS: On the basis of the 3 deaths from general anesthesia occurring in the MRI suite, the resulting non-OR mortality rate at our institution was approximately 1 in 3900. Comparatively, in the same period, our mortality rate for procedures performed intraoperatively under general anesthesia was 1 in 7138. Therefore, there is almost a 2-fold increased risk in mortality associated with non-OR versus OR anesthetics at our institution. CONCLUSION: Our analysis shows that the administration of anesthesia in MRI suite possesses inherent risks that might be the same or even higher than those in the OR. BACKGROUND: Over the last 2 decades, the scope of anesthesia practice has expanded to include remote sites away from the operating room. As the number of diagnostic and therapeutic interventions performed outside the operating room continues to increase, anesthesiologists are being faced with challenges of providing care for more medically complex patients while adapting to fewer resources, with lack of support system commonly available in the operating room. In this article, we present three pediatric cases resulting in poor outcomes, all of which occurred in our MRI suite.

Pulmonary atelectasis in children anesthetized for cardiothoracic MR: evaluation of risk factors.

PURPOSE: To systematically assess the frequency and risk factors for atelectasis in children anesthetized for cardiothoracic magnetic resonance (MR). MATERIALS AND METHODS: We retrospectively identified 58 consecutive children (age range, 6 days to 21 years) who underwent cardiothoracic MR from January 2001 to December 2004 whose imaging and medical charts were available. One certificate of added qualification pediatric radiologist and 1 of 2 cardiothoracic radiologists, in consensus, evaluated the first and last set of axial images. Images were evaluated for cardiac, vascular and tracheobronchial abnormalities, and degree of atelectasis. Atelectasis was considered significant if the equivalent of 3 or more segments were involved. Patients received 1 or more of 7 anesthetic medications (n = 27), chloral hydrate alone (n = 4), or required no anesthesia (n = 27). RESULTS: Significant atelectasis developed only in those receiving anesthetic medications. Thirty-seven percent (10/27) of anesthetized children developed significant atelectasis in the first and/or last axial sequence. In 90% (9 /10) of patients, it developed in the first axial sequence. Strong risk factors were age younger than 1 year (80%, 8/10, P = 0.029) and MR evidence of tracheobronchial narrowing (50%, 5/10, P = 0.008). In patients with vascular ring, there was a trend toward significance (40%, 4/10, P = 0.09). None of the anesthesia factors were significant, including ventilation mode, anesthesia duration, or American Society of Anesthesiology risk (all P > 0.1). CONCLUSIONS: Atelectasis may occur shortly after induction of anesthesia in children younger than 1 year of age or with tracheobronchial narrowing when anesthetized for cardiothoracic MR.

Anesthetic management of staged separation of craniopagus conjoined twins.

We present a case of successful separation of craniopagus conjoined twins. The procedure was staged to permit each child to develop adequate independent cerebral venous drainage and to prevent deleterious, perioperative cerebral edema. Surgical hemorrhage, blood product delivery, and hemodilution were minimized.

The postoperative cardiovascular arrest of a 5-year-old male: an initial presentation of Duchenne's muscular dystrophy.

Anesthesia may be administered to patients with Duchenne's muscular dystrophy, but cases are reported in which apparently healthy children suffer hyperkalemic cardiac arrest. We present the case of a 5-year-old boy whose muscular dystrophy was discovered following a fatal, perioperative cardiac arrest in the postanesthesia care unit.