Double aortic arch presenting with respiratory distress: A case report and review of the literature.

Tracheal compression by vascular structures in infants is uncommon and may be masked by nonspecific respiratory symptoms. Double aortic arch (DAA) is the most common vascular ring. We describe a case of a 9-month-old male infant presented with respiratory distress and found to have a DAA. In this report, the authors emphasize the consideration of this pathology-induced respiratory distress and discuss its anesthetic management.

Anaesthetic management for awake craniotomy in brain glioma resection: initial experience in Military Hospital Mohamed V of Rabat.

The awake brain surgery is an innovative approach in the treatment of tumors in the functional areas of the brain. There are various anesthetic techniques for awake craniotomy (AC), including asleep-awake-asleep technique, monitored anesthesia care, and the recent introduced awake-awake-awake method. We describe our first experience with anesthetic management for awake craniotomy, which was a combination of these techniques with scalp nerve block, and propofol/rémifentanil target controlled infusion. A 28-year-oldmale underwent an awake craniotomy for brain glioma resection. The scalp nerve block was performed and a low sedative state was maintained until removal of bone flap. During brain glioma resection, the patient awake state was maintained without any complications. Once, the tumorectomy was completed, the level of anesthesia was deepened and a laryngeal mask airway was inserted. A well psychological preparation, a reasonable choice of anesthetic techniques and agents, and continuous team communication were some of the key challenges for successful outcome in our patient.

[Rare etiology of subocclusive syndrome: inflammatory fibroid polyp of the ileum, about a clinical case]. / Etiologie rare d'un syndrome subocclusif: polype fibrinoïde inflammatoire de l'iléon, à propos d'un cas clinique.

Inflammatory fibroid polyp (IFP) is a rare benign lesion, originating from the submucosa in the gastrointestinal tract. It generally appears as an isolated benign lesion, rarely located at the level of the ileum. Its origin is controversial. Clinical presentation varies depending on its location; invagination and obstruction are the most common indicative symptoms when the polyp is located at the level of the small intestine. We report the case of a 22-year old patient with abdominal pain, nausea and vomiting and a personal history of intermittent constipation and a weight loss during the previous year. Radiological imaging objectified ileo-ileal invagination completely obstructing the ileum light. Segmental resection of the obstructed ileal segment and termino-terminal anastomosis were performed. The final diagnosis of IFP was established using histological examination and immunohistochemical investigation.

Unplanned Intensive Care Unit Admission following Elective Surgical Adverse Events: Incidence, Patient Characteristics, Preventability, and Outcome.

CONTEXT: Adverse events (AEs) are a persistent and an important reason for Intensive Care Unit (ICU) admission. They lead to death, disability at the time of discharge, unplanned ICU admission (UIA), and prolonged hospital stay. They impose large financial costs on health-care systems. AIMS: This study aimed to determine the incidence, patient characteristics, type, preventability, and outcome of UIA following elective surgical AE. SETTINGS AND DESIGN: This is a single-center prospective study. METHODS: Analysis of 15,372 elective surgical procedures was performed. We defined UIA as an ICU admission that was not anticipated preoperatively but was due to an AE occurring within 5 days after elective surgery. STATISTICAL ANALYSIS: Descriptive analysis using SPSS software version 18 was used for statistical analysis. RESULTS: There were 75 UIA (0.48%) recorded during the 2-year study period. The average age of patients was 54.64 ± 18.02 years. There was no sex predominance, and the majority of our patients had an American Society of Anesthesiologist classes 1 and 2. Nearly 29% of the UIA occurred after abdominal surgery and 22% after a trauma surgery. Regarding the causes of UIA, we observed that 44 UIA (58.7%) were related to surgical AE, 24 (32%) to anesthetic AE, and 7 (9.3%) to postoperative AE caused by care defects. Twenty-three UIA were judged as potentially preventable (30.7%). UIA was associated with negative outcomes, including increased use of ICU-specific interventions and high mortality rate (20%). CONCLUSIONS: Our analysis of UIA is a quality control exercise that helps identify high-risk patient groups and patterns of anesthesia or surgical care requiring improvement.

Anesthesia for endoscopic retrograde cholangiopancreatography: target-controlled infusion versus standard volatile anesthesia.

BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) is a technique used both for diagnosis and for the treatment of biliary and pancreatic diseases. ERCP has some anesthetic implications and specific complications. The primary outcome aim was to compare two protocols in terms of time of extubation. We also compared anesthetic protocols in terms of hemodynamic and respiratory instability, antispasmodics needs, endoscopist satisfaction, and recovery room stay. METHODS: Patients were randomized into two groups standard anesthesia group (Gr: SA) in whom induction was done by propofol, fentanyl and cisatracurium and maintenance was done by a mixture of oxygen, nitrousoxide (50%:50%) and sevoflurane; and intravenous anesthesia group to target concentration (Gr: TCI) in whom induction and maintenance of anesthesia were done with propofol with a target 0.5-2 µg/mL, and remifentanil with a target of 0.75-2 ng/mL. RESULTS: 90 patients were included. Extubation time was shorter in Gr: TCI, 15±2.6 vs. 27.4±7.1 min in Gr: SA (P<0.001). The incidence of hypotension was higher in GrL: SA (P=0.009). Satisfaction was better in Gr: TCI (P=0.003). Antispasmodic need was higher in Gr: SA (P=0.023). Six patients in Gr: SA group had desaturation in post-anesthesia care unit (PACU) versus one patient from Gr: TCI (P=0.049). Patients in Gr: TCI had shorter PACU stay 40.2±7.3 vs. 58.7±12.4 min (P<0.001). CONCLUSION: The use of TCI mode allows better optimization of general anesthesia technique during ERCP.

[Depressed skull fracture following the use of Mayfield headrest in adult patients: about a case and review of the literature]. / Embarrure suite à l'utilisation de la têtière de Mayfield chez l'adulte: à propos d'un cas et revue de la literature.

Many neurosurgical procedures involve the use of a pin-type headrest to immobilize the patient's head. We report the case of depressed skull fracture in an adult patient secondary to the use of Mayfield headrest. The diagnosis was based on postoperative CT scan of the brain following surgical resection of medulloblastoma. Several factors seem to increase the risk of complications due to Mayfield headrest use. Preventive measures are outlined in our literature review.

Use of sugammadex in parotid surgery: a case report.

BACKGROUND: Parotid surgery is a common ear, nose, and throat procedure. Facial nerve paralysis is the main feared complication following this surgery. To avoid this paralysis, intraoperative facial nerve monitoring is often used, but neuromuscular blocking agents interfere with this technique. Therefore, the neuromuscular blocking agent used should have a short duration of muscle relaxation. With the discovery of sugammadex, a steroidal neuromuscular blocking agent has acquired the potential to be used in place of succinylcholine. CASE PRESENTATION: A 41-year-old African woman was scheduled for a parotidectomy at our hospital. Rocuronium-induced neuromuscular block was reversed intraoperatively with sugammadex to facilitate identification of facial nerve function. The facial nerve was identified without incident, and surgical conditions were good for the removal of the tumor. During postoperative follow-up, no evidence of residual paralysis has been noted. CONCLUSIONS: In parotid surgery, the use of sugammadex allows free use of a steroidal neuromuscular blocking agent for intubation and thus intraoperative facial nerve monitoring can be done safely.

Henna dye: A cause of erroneous pulse oximetry readings.

Pulse oximetry is a noninvasive and continuous monitoring of the pulsed saturation of hemoglobin oxygen. Because of its simplicity and usefulness, it is part of monitoring recommended for any anesthesia in the operating room. Different factors may limit the use of this monitoring. We report a case of difficulty monitoring by the presence of henna in a patient scheduled for general anesthesia in prone position.

Anaphylactic shock during hydatid cyst surgery.

Intraoperative anaphylactic shock is an unusual complication. Different causes can be involved. Surgery of hydatid cyst is rarely responsible. About a case report of anaphylactic shock due to hydatid cyst surgery, the authors discuss the mechanisms, principles of treatment, and prevention measures of this complication.

[Fatal evolution of a left brachio-cephalic vein perforation by a catheter for hemodialysis]. / Évolution fatale d'une perforation du tronc veineux brachio-céphalique gauche par un cathéter d'hémodialyse.

Central venous catheterisation is a common procedure in intensive care and hemodialysis units. Tunnelled catheters of hemodialysis are a great contribution for patients for whom an arteriovenous fistula is not feasible, especially for prolonged use. However, multiple complications have been described from their practice. Through a case of perforation of the left brachio-cephalic vein with a venous catheter for dialysis and a review of the literature, the authors discuss the mechanisms and ways to prevent this complication.