Self-Limited Spinal Subarachnoid Hemorrhage After Lumbar Spinal Drain Removal While on Clopidogrel: A Case Report Spinal subarachnoid hemorrhage (SSH) is a rare yet potentially devastating complication of neuraxial procedures. We present a case of SSH after inadvertent lumbar spinal drain removal while on clopidogrel. The contrast between the patient’s mild clinical symptoms compared to his impressive magnetic resonance imaging (MRI) highlights the variable presentations that can be seen with spinal and epidural hematomas. Despite sophisticated electronic warnings systems available to improve patient safety, better efforts are needed to improve interprofessional communication with providers taking care of patients with indwelling neuraxial catheters. Accepted for publication August 26, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Dalia H. Elmofty, MD, Department of Anesthesiology, University of Chicago, 5841 S Maryland Ave, Chicago, IL 60637. Address e-mail to delmofty@dacc.uchicago.edu. © 2019 International Anesthesia Research Society

Absence of Adverse Neurological Outcomes in a Non-Neurologically Injured Polytrauma Patient Despite Extreme and Prolonged Treatment-Resistant Hypotension: A Case Report Temporary hypotension after severe trauma might help achieve hemostasis and increase the chances of survival. However, excessive hypotension can lead to adverse neurological sequelae or be fatal. The relationship between the degree of hypotension and neurological prognosis after trauma is not fully understood. Our report describes a patient with severe trauma who survived with a favorable neurological outcome despite extreme and prolonged treatment-resistant hypotension. Accepted for publication August 20, 2019. Funding: None. The authors declare no conflicts of interest. The Ethics Committee at Kitami Red Cross Hospital approved this study. Address correspondence to Wataru Sakai, MD, Department of Anesthesiology, Sapporo Medical University School of Medicine, W 16, S 1, Chuo-ku, Sapporo, Hokkaido 060-8556, Japan. Address e-mail to sakaiwataru1128@gmail.com. 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

Unilateral Lung Recruitment Maneuver for Massive Atelectasis in a Child With Glenn Circulation: A Case Report A 9-year-old girl with Glenn circulation suffered from massive atelectasis of the left lung caused by bleeding during cardiac catheterization. The atelectasis resulted in frequent hypoxia leading to oxygen saturation (SpO2) of 40%–50%. In the intensive care unit, we performed a unilateral lung recruitment maneuver (ULRM) for 2 days. The ULRM involved placement of a bronchial blocker in the right main bronchus and application of continuous positive airway pressure to the left lung without hemodynamic deterioration. Eventually, SpO2 improved to 80%–85%. ULRM can be a treatment option for unilateral atelectasis in a child with Glenn circulation. Accepted for publication August 22, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Tomoyuki Kanazawa, MD, PhD, Department of Anesthesiology and Resuscitology, Okayama University Hospital, 2-5-1 Shikata-cho, Kita-ku, Okayama-city, Okayama, Japan 7008558. Address e-mail to tyskanazawa@gmail.com. © 2019 International Anesthesia Research Society

Spontaneous Resolution of Gravid Uterine Incarceration With Spinal Anesthesia: A Case Report Incarceration of the gravid uterus may pose significant risks to both maternal and fetal health. Anesthetic management for these patients is variable, and the ideal anesthetic technique is unknown. The patient presented to the labor and delivery unit with pelvic pain and urinary retention in the setting of a gravid incarcerated uterus. Previous attempts at manual reduction in the outpatient setting were unsuccessful. A combined spinal-epidural anesthetic was administered, followed by spontaneous resolution of the incarcerated uterus. In addition to providing analgesia, neuraxial blockade may occasionally be an adequate therapeutic technique for reduction of a gravid incarcerated uterus. Accepted for publication August 26, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Matthew G. Hire, MD, Department of Anesthesiology, Northwestern University Feinberg School of Medicine, 251 E. Huron St, F5-704, Chicago, IL 60611. Address e-mail to matthew-hire@northwestern.edu. © 2019 International Anesthesia Research Society

Black Seed Oil and Perioperative Serotonin Syndrome: A Case Report Perioperative serotonin syndrome has been associated with a number of medications and herbal supplements. We report a patient who developed serotonin syndrome immediately after an endoscopic procedure in which the preoperative use of black seed oil appears to have played a role in stimulating the syndrome. Black seed oil has not been previously reported in association with perioperative serotonin syndrome. Anesthesia professionals should be aware that patients taking black seed oil supplements may develop serotonin syndrome postoperatively. Accepted for publication August 20, 2019. Funding: None The authors declare no conflicts of interest. Address correspondence to Mary E. Warner, MD, Department of Anesthesiology, Mayo Clinic, 1-145 Charlton Bldg, 200 First St SW, Rochester, MN 55905. Address e-mail to warner.mary@mayo.edu. © 2019 International Anesthesia Research Society

Epicardial Echocardiography as Rescue Modality for Detection of Dynamic Right Ventricular Outflow Tract Obstruction in Post Pulmonary Valve Stenosis Repair No abstract available

Role of Ultrasound in Emergency Front of Neck Access: A Case Report and Review of Literature Emergency front of neck access (eFONA) is a lifesaving procedure in a cannot intubate cannot oxygenate (CICO) situation. We report a case of a patient who presented to the emergency department (ED) in extremis with a difficult airway. A history of multiple neck surgeries and permanent tracheostomy from birth until the age of 17 years complicated his airway management. Altered neck anatomy led to failed intubation and oxygenation. EFONA was established with the use of rapid ultrasound imaging and using the scalpel-bougie-tube technique. We present a review of literature relating to the use of ultrasound during emergency airway management. Accepted for publication August 7, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Umair Ansari, FCAI, University Hospitals Coventry and Warwickshire NHS Trust, Clifford Bridge Road, Coventry, CV2 2DX, United Kingdom. Address e-mail to umair.ansari@uhcw.nhs.uk. © 2019 International Anesthesia Research Society

Iatrogenic Bladder Perforation During Laparoscopy: Revisiting the “Catheter Bag” Sign: A Case Report We report a case of an iatrogenic bladder perforation sustained during laparoscopic lysis of adhesions performed for small bowel obstruction. The only sign, discovered by the anesthesiology team, was an inflated urinary catheter collection bag. This case revalidates the “catheter bag” sign and advocates for the placement of an indwelling transurethral urinary catheter before surgical incision in high-risk patients with previous pelvic and/or bladder pathology. In addition, vigilance from anesthesia providers and commitment to communication between anesthesia, surgical, and nursing care teams is emphasized to quickly discover complications and treat accordingly. Accepted for publication August 20, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Jeffrey S. Grzybowski, MD, Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave B6/319 CSC Madison, WI 53792. Address e-mail to JGrzybowski@uwhealth.org. © 2019 International Anesthesia Research Society

Thermal Radiofrequency Ablation of the Articular Branch of the Lateral Pectoral Nerve: A Case Report and Novel Technique The lateral pectoral nerve (LPN) innervates anterior shoulder structures. We report a novel technique for radiofrequency ablation (RFA) of the articular branch of the LPN (abLPN) to treat persistent anterior shoulder pain. Ultrasound and fluoroscopy were used to identify bony and vascular landmarks to target the midlateral and superior-lateral coracoid process (CP). Multiple thermal RFA lesions were delivered along this location without complication using a 20-gauge cannula. As a result, the patient has continued substantial relief of resting and dynamic deep anterior shoulder pain beyond 3 months. Ablation of the abLPN may provide anterior shoulder analgesia without causing motor weakness. Accepted for publication July 31, 2019. Conflicts of Interest: See Disclosures at the end of the article. Funding: Resources required to produce and publish this case report were funded by the Department of Anesthesiology, University of Texas Health Science Center at San Antonio. Address correspondence to Maxim S. Eckmann, MD, Department of Anesthesiology, University of Texas Health Science Center at San Antonio, Mail Code 7838, 7703 Floyd Curl Dr, San Antonio, TX 78229. Address e-mail to eckmann@uthscsa.edu. © 2019 International Anesthesia Research Society

Heparin-Induced Thrombocytopenia and Cardiac Surgery: Can We Do It All With Cangrelor? No abstract available