Perioperative anesthetic management of an 18-month-old pediatric patient with a congenital coronary fistula between the left circumflex coronary artery and coronary sinus: Report of a rare case.

We present a case of an 18-month-old, 8.69 kg, female, who presented with a coronary fistula between the left circumflex coronary artery and coronary sinus (CS) for remote computed tomography (CT) imaging and transcatheter closure. This is the fifth published case report to describe this congenital anomaly and the first to discuss general anesthesia (GA) and the hemodynamic management considerations for the anesthesiologist.

Anesthesia Lost in Translation: Perspective and Comprehension.

BACKGROUND: Care of non-English speaking patients poses a unique challenge to the anesthesiologist in the perioperative setting. Communication limitations can be frustrating to both the patient and provider, and at times can compromise the quality of care, resulting in health care disparities. An often overlooked, but critical component is the interaction between the anesthesia provider and the interpreter. The goal of our study was to identify misconceptions regarding anesthesia and determine common knowledge gaps amongst medical interpreters. METHODS: A survey inquiring about past perioperative experiences, level of training, and barriers to effective communication was sent to the Department of Interpreter Services (IS). Concurrently, a survey was sent to the Department of Anesthesia, about their experiences with interpreters in the perioperative setting. RESULTS: Our survey had 29 respondents from IS and 42 respondents from Anesthesia. 85% of interpreters had >5 years experience, but 96% denied having anesthesia specific training. Additionally, 42.5% of our interpreters felt that less than half of their patients were sufficiently literate to read and consent in their native language. Anesthesia providers were primarily concerned about the fidelity of the interpretation. CONCLUSIONS: Misunderstanding one another's field appears to play a significant role in the communication issues surrounding interpretation for anesthesia. Educating both departments may prove beneficial to resolving misconceptions, improving perioperative interactions and ultimately improving patient care. Based on the gathered information, a continuing education lecture was created by the Anesthesia Department in order to improve our interpreters' understanding of anesthesia, associated procedures and vocabulary.

Recognition of a Thoracic Epidural Hematoma in the Setting of Transient Paralysis: A Case Report.

A 71-year-old woman on aspirin presented for a distal pancreatectomy, splenectomy, and partial colectomy with a T8/9 epidural catheter placed preoperatively in 3 attempts. Prophylactic 5000 units of subcutaneous heparin were given before the procedure. After catheter removal on postoperative day 2, the patient developed transient bilateral lower extremity paralysis, with near complete recovery within 30 minutes. An urgent MRI revealed a T4-T8 epidural hematoma prompting an emergent T3-T8 laminectomy. This case presentation highlights the need for heightened awareness regarding complications related to neuraxial analgesia in patients receiving unfractionated heparin for thromboembolism prophylaxis with concurrent aspirin use.

Teaching sonoanatomy to anesthesia faculty and residents: utility of hands-on gel phantom and instructional video training models.

STUDY OBJECTIVE: Thousands of patients worldwide annually receive neuraxial anesthesia and analgesia. Obesity, pregnancy, and abnormal spinal anatomy pose challenges for accurate landmark palpation. Further, spinal sonoanatomy is not uniformly taught in residency education, even though its use has previously been shown to improve identification of relevant structures and decrease procedural complications and failure rates. The aim of this study was to evaluate the use of hands-on gel phantom and instructional video training for teaching spinal sonoanatomy among anesthesiology faculty and residents. DESIGN: Twenty-three residents and 27 anesthesiologists were randomized to gel phantom, video teaching, and control groups. SETTING: Academic Hospital. MEASUREMENTS: Successful identification of spinal sonoanatomy was attempted on a human volunteer before and immediately after the respective intervention and 3 weeks later. Perceived knowledge and training modality satisfaction were assessed using modified Likert scales. INTERVENTIONS: Gel phantom and video teaching groups compared with control (no intervention). MAIN RESULTS: Both interventions significantly improved spine sonoanatomy identification accuracy. Logistic regression analysis demonstrated both interventions improved the odds of transverse process (gel 12.61, P = .013; video 7.93, P = .030) and lamina (gel 65.12, P = .003; video 8.97, P = .031) identification. Perceived knowledge of basic spinal anatomy and spinal sonoanatomy improved in the intervention versus control groups. Mean (SD) modified Likert scale scores for learning satisfaction (1 = unsatisfied, 10= very satisfied) were 8.1 (1.5) and 8.0 (1.7) for hands-on gel phantom and instructional video training participants, respectively. CONCLUSION: Use of hands-on gel phantom or instructional video training can improve anesthesia staff and resident knowledge of lumbar spine sonoanatomy.

Treatment of recalcitrant excessive granulation tissue with photodynamic therapy in an eight-year-old patient with focal dermal hypoplasia syndrome.

We report a pediatric patient with focal dermal hypoplasia syndrome who developed painful excessive granulation tissue refractory to traditional medical and surgical therapies. Complete response was achieved rapidly with a combination of photodynamic therapy and intralesional steroid injections. The patient has remained in remission for longer than a year.

Wisconsin stillbirth services program: a multifocal approach to stillbirth analysis.

Stillbirth accounts for about 26,000 deaths annually in the US. In most previous studies, discrete causes are identified in less than half of all stillbirths. In order to identify causes and non-causal but potentially contributing abnormalities, we analyzed 416 of the most recent (2004-2010) Wisconsin Stillbirth Service Program (WiSSP) cases from a multifocal approach. In 70% of cases a cause sufficient to independently explain the demise was identified including 40% placental, 21.5% fetal, and 12.7% maternal. Results for stillbirths and second trimester miscarriages did not differ significantly. In 95% of cases at least one cause or non-causal abnormality was recognizable, and in two-thirds of cases, more than one cause or non-causal abnormality was identified. In cases with maternal cause, the placenta was virtually always abnormal. Both placentas (59%) and fetuses (38%) were frequently smaller than expected for gestational age. Previous miscarriage and/or stillbirth were risk factors for second and third trimester losses, with 35% of previous pregnancies ending in fetal demise. Recommendations include complete evaluation of all second and third trimester losses with special attention to placental pathology and thorough investigation for multiple causes or abnormalities whether or not a primary cause is initially recognized. Improved understanding of the causes of late miscarriage and stillbirth may contribute to recognition and management of pregnancies at risk and eventually to prevention of stillbirth.