Anesthesia in the Form of Audiovisual Distraction for a Child Requiring Surgery With End-Stage Cardiomyopathy: A Case Report Anesthetizing children with extreme cardiopulmonary illness can be especially challenging. In adults, a host of alternatives to general anesthesia for the labile patient are available, However, in children, these techniques may be challenging due to a lack of patient cooperation. Distraction techniques have been successfully used to reduce procedural pain. The patient whose case is reported here required surgery for inguinal hernia repair after repeated bowel incarceration. Due to severe end-stage cardiomyopathy, the risk of general anesthesia was deemed excessive. Distraction was used to usher the patient through an awake caudal block for avoidance of general anesthesia. Accepted for publication July 19, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Adam C. Adler, MD, MS, FAAP, FASE, Texas Children’s Hospital, Baylor College of Medicine, 6621 Fannin St, Suite #A3300, Houston, TX 77030. Address e-mail to adam.adler@bcm.edu. © 2019 International Anesthesia Research Society

Bilateral Cavernous Sinus Syndrome, Pituitary Macroadenoma, and Postoperative Loss of Vision: A Case Report Postoperative vision loss is a rare complication. When visual loss does occur, it is rarely associated with ophthalmoplegia. We report a case of postoperative bilateral visual field deficits with concomitant complete bilateral ophthalmoplegia in a patient with a known pituitary macroadenoma after surgical excision of a small cell carcinoma of the bladder. Emergency postoperative imaging showed that the macroadenoma had increased in size and was associated with new right optic nerve edema. The patient underwent urgent excision of the macroadenoma 5 days after the onset of symptoms. Visual field deficits and associated ophthalmoplegia had completely resolved at 3-month follow-up. Accepted for publication July 19, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Thomas M. Stewart, MD, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, 200 1st St SW, Rochester, MN 55902. Address e-mail to stewart.thomas1@mayo.edu. © 2019 International Anesthesia Research Society

Relief of Neuropathic Pain After Spinal Cord Stimulator Implantation in a Patient With Idiopathic Thoracic Transverse Myelitis: A Case Report Transverse myelitis (TM) is a rare neurologic disorder of acute inflammation resulting in spinal cord injury. Chronic pain in TM is a significant detriment to quality of life. Spinal cord stimulation (SCS) is an emerging treatment that has shown significant efficacy in neuropathic pain. We present a 37-year-old man with a history of idiopathic thoracic TM and refractory chronic neuropathic pain who underwent an SCS trial. He reported 70% improvement during the trial and was subsequently implanted with an SCS. He continues to experience significant pain relief and functional improvement (>80%) with conventional paresthesia programming at the 9-month follow-up. Accepted for publication July 15, 2019. Funding: None. Conflicts of Interest: See Disclosures at the end of the article. Address correspondence to Rajiv Reddy, MD, Department of Anesthesia, Pain Medicine, University of California San Diego Health Center, La Jolla, CA 92037. Address e-mail to rajiv.d.reddy@gmail.com. © 2019 International Anesthesia Research Society

Point-of-Care Lung Ultrasound for Bronchial Blocker Placement No abstract available

Bilateral Visual Loss After Spine Surgery in a Patient With Midfacial Trauma: A Case Report We present a case of bilateral visual loss in a patient who underwent spine surgery after sustaining a fall and trauma to her face and cervical spine. Visual loss in the right eye, not recognized until after surgery, was a result of blunt injury to the eye. Visual loss in the left eye was caused by posterior ischemic optic neuropathy, an unfortunate complication of surgery in the prone position. Accepted for publication June 17, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Tomasz Polis, MD, FRCPC, Department of Anesthesiology and Pain Medicine, University of Ottawa, The Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada. Address e-mail to tpolis@toh.ca. © 2019 International Anesthesia Research Society

Physical Dependence in Patient With Chronic Low Back Pain Treated With Topiramate: A Case Report In the last decade, prescription of anticonvulsants for treatment of low back pain (LBP) increased 4-fold. Among them, topiramate has frequent side effects and a mechanism of action that is not fully understood. The authors describe a 65-year-old woman with dependence on topiramate prescribed for chronic LBP and discuss how she was successfully weaned off topiramate using duloxetine. A significant agonistic effect by topiramate on α-2 adrenergic receptors in the brain likely accounts for the symptoms of withdrawal that were seen. We attribute the resolution of her topiramate withdrawal symptoms to reduced norepinephrine (NE) release, a known effect of duloxetine administration. Accepted for publication June 27, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Roscoe H. Bratton, BA, James H. Quillen College of Medicine, East Tennessee State University, 178 W Maple St, Johnson City, TN 37604. Address e-mail to bratrh7@gmail.com. © 2019 International Anesthesia Research Society

Focused Transesophageal Echocardiography for Bedside Diagnosis of Iatrogenic Cardiac Perforation: A Case Report We describe an extremely rare complication of chest tube placement and focused transesophageal echocardiography (TEE) in the diagnosis of a life-threatening condition. It illustrates the value and utility of point-of-care ultrasound (POCUS) by way of a focused TEE in confirming a diagnosis and contributing toward the expeditious operative management of a life-threatening scenario. POCUS continues to gain traction in the field of anesthesiology. However, incorporation of POCUS training into curriculum of anesthesia residency programs is still in the infancy stages. Our report demonstrates the need for development and standardization of POCUS training for anesthesiologists in the perioperative setting. Accepted for publication July 15, 2019. Funding: The authors’ work was supported and funded in part by the National Institutes of Health/NCI Cancer Center Support Grant P30 CA008748. The authors declare no conflicts of interest. Address correspondence to Cindy B. Yeoh, MD, Department of Anesthesiology and Critical Care Medicine, Memorial Sloan Kettering Cancer Center, 1275 York Ave, New York, NY 10065. Address e-mail to yeohc@mskcc.org. © 2019 International Anesthesia Research Society

Suture Catheter for Rescue Perineural Catheter Placement When Unable to Position a Conventional Through-the-Needle Catheter: A Case Report The main purported benefit of suture-style catheters is the ability to secure the catheter at 2 sites, thereby decreasing the likelihood of catheter dislodgement. An additional benefit is the ability to precisely control the placement of the orifice to infuse local anesthetic. Here we present the case of a patient undergoing open ankle surgery for whom placement of a conventional through-the-needle popliteal sciatic perineural catheter for postoperative analgesia was attempted. Despite multiple attempts, the catheter repeatedly advanced beyond the nerve. Placement of a suture catheter was then attempted, and the catheter was successfully placed on the first attempt. Accepted for publication July 1, 2019. Funding: The suture catheter used in this study was provided by Ferrosan Medical Devices. Conflicts of Interest: See Disclosures at the end of the article. Address correspondence to John J. Finneran, IV, MD, Department of Anesthesiology, University of California, San Diego, 200 W Arbor Dr MC 8770, San Diego, CA 92103. Address e-mail to jfinneran@ucsd.edu. © 2019 International Anesthesia Research Society

Single-Lumen Endotracheal Tube and Bronchial Blocker for Airway Management During Tracheobronchoplasty for Tracheobronchomalacia: A Case Report We present a case of a 69-year-old man who underwent tracheobronchoplasty for tracheobronchomalacia using a single-lumen endotracheal tube and a Y-shaped bronchial blocker for airway management. Tracheobronchoplasty is performed by sewing mesh to plicate the posterior, membranous wall of the distal trachea and main bronchi through a right posterolateral thoracotomy. The goals of airway management include continuous left-lung ventilation and lung protection from aspiration. Ideally, only conventional airway management tools are used. This case demonstrates that a single-lumen endotracheal tube with a bronchial blocker can be a straightforward strategy for airway management during tracheobronchoplasty. Accepted for publication June 27, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Natalie S. Lui, MD, Department of Cardiothoracic Surgery, Stanford University, 300 Pasteur Dr, Falk Bldg, Stanford, CA 94305. Address e-mail to natalielui@stanford.edu. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal. © 2019 International Anesthesia Research Society

Cardiovascular Collapse in a Patient With Parotid Abscess: Dangerous Cross Talk Between the Brain and Heart: A Case Report Postsurgical trigeminal neuralgia (TN), although rare, can lead to significant hemodynamic perturbations by triggering the trigeminocardiac reflex (TCR). The combination can lead to diagnostic as well as management challenges for clinicians. We present the case of a patient with a parotid abscess, which developed as a complication of his otolaryngologic surgery, and which led to repeated episodes of symptomatic bradycardia associated with cardiovascular collapse. This case highlights the importance of heightened awareness, early diagnosis, and timely treatment of postsurgical neuropathic pain syndromes to avoid life-threatening complications. Accepted for publication May 16, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Kunal Karamchandani, MD, FCCP, Department of Anesthesiology and Perioperative Medicine, Penn State Health Milton S. Hershey Medical Center, H187, 500 University Dr, Hershey, PA 17033. Address e-mail to kkaramchandani@pennstatehealth.psu.edu. © 2019 International Anesthesia Research Society