Ultrasound-Guided Hydrodissection of an Entrapped Saphenous Nerve After Lower Extremity Varicose Vein Stripping: A Case Report A 78-year-old woman complained of numbness, tingling, and pain in the left leg 6 months after greater saphenous vein stripping. Ultrasonography identified a mass adjacent to the saphenous nerve at the scar. Ultrasound-guided hydrodissection separated the mass from the nerve. The pain disappeared after hydrodissection, and the patient remained pain free for 3 days. The visual analog pain scale decreased from 80 (before treatment) to 60 three days later. The hydrodissection was repeated weekly for a total of 8 times, and the pain completely resolved 4 months later. Ultrasound-guided hydrodissection is effective to treat nerve entrapment after lower extremity varicose vein stripping. Accepted for publication October 16, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Kunitaro Watanabe, MD, PhD, Department of Anesthesiology, Kyorin University School of Medicine, 6-20-2 Sinkawa, Mitaka, Tokyo 181-8611, Japan. Address e-mail to kunitarowatanabe@yahoo.co.jp. 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

Partial Unroofed Coronary Sinus: An Uncommon Cause of Postcardiac Surgery Hypoxemia No abstract available

Neuraxial Anesthesia and Lower Extremity Peripheral Nerve Blocks for Ankle Surgery in a Patient With Chronic Inflammatory Demyelinating Polyneuropathy: A Case Report Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare autoimmune disease that targets the peripheral nervous system. The literature on the use of regional anesthesia in CIDP is limited. We report a patient with CIDP who received a combined spinal-epidural (CSE) and saphenous and popliteal peripheral nerve blocks (PNBs) for ankle surgery. The CSE and PNBs resolved without incident. On approximately the fourth postoperative day, the patient reported a worsening of baseline CIDP symptoms in all extremities. Given the diffuse presentation, the CIDP exacerbation was attributed to the perioperative stress response. The exacerbation improved by 4 months postoperatively. Accepted for publication October 16, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Ashley V. Wells, MD, Division of Regional Anesthesiology and Acute Pain Medicine, Weill Cornell Department of Anesthesiology, P300, New York Presbyterian Hospital, 525 E 68th St, New York, NY 10065. Address e-mail to awells2245@gmail.com. © 2019 International Anesthesia Research Society

Use of Pilot Balloon to Fish Out Fractured Tracheostomy Tube: A Case Report Tracheostomy is a weaning technique in patients requiring prolonged ventilation. During this period, complications like tube blockage, fracture of the tracheostomy tube, or cuff rupture can occur. Fracture of the tracheostomy tube can result in the distal end of the tube being dislodged further down the trachea, leading to airway obstruction and hypoxia. We report fracture of a tracheostomy tube in which the distal end was removed, using the inflation line of the pilot balloon to pull out the broken end of the tracheostomy tube. Accepted for publication October 21, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Nikhil Kothari, MD, PhD, Department of Anaesthesiology & Critical Care, All India Institute of Medical Sciences, OT 3rd Floor, OPD Block, Jodhpur, India. Address e-mail to drnikhilkothari@gmail.com. © 2019 International Anesthesia Research Society

Dynamic Tracheobronchial Compression in Steep Trendelenburg Position With Pneumoperitoneum for Robotic-Assisted Cystectomy: A Case Report Tracheobronchomalacia is a weakness of the trachea and bronchi due to abnormal cartilage and muscular support leading to airway obstruction. We report a case of an adult former smoker without pulmonary symptoms who underwent robotic-assisted laparoscopic cystectomy in the steep Trendelenburg position. After repeated episodes of hypoxemia, bronchoscopic examination revealed collapse of the distal trachea and bronchi, supporting a diagnosis of tracheobronchomalacia. Tracheomalacia is an underdiagnosed condition in patients with a smoking history and may mimic other obstructive diseases. The anesthesiologist should remain vigilant to the possibility of airway collapse in former smokers, specifically in cases of increased intrathoracic pressure. Accepted for publication October 4, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Daniel M. Gainsburg, MD, MS, Department of Anesthesiology, Perioperative and Pain Medicine, Icahn School of Medicine, The Mount Sinai Medical Center, One Gustave L. Levy Place, New York, NY 10029. Address e-mail to daniel.gainsburg@mountsinai.org. © 2019 International Anesthesia Research Society

Intraoperative Multipoint Acupuncture for Reducing Postoperative Nausea and Vomiting in High-Risk Children: A Case Series Acupuncture studies have demonstrated varying effects on pediatric postoperative nausea and vomiting (PONV). Unanswered questions include whether the type of therapy, number of points used, or timing of treatments vary the effect of acupuncture. We present a case series of intraoperative multipoint acupuncture treatments for high-risk pediatric patients. Fourteen patients were included, and 19 treatments were provided. Twelve patients (85.7%) had previous PONV. Patients who received intraoperative acupunctur e reported no early phase PONV, and 3 patients (15.8%) reported late-phase PONV. One patient required postoperative antiemetics. Intraoperative multipoint acupuncture may be a safe and efficacious adjunct for PONV in high-risk pediatric patients. Accepted for publication October 4, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Joelle B. Karlik, MD, Department of Anesthesiology and Pain Medicine, Emory University, Egleston Children’s Hospital, 1405 Clifton Dr, Atlanta, GA 30307. Address e-mail to joelle.b.karlik@emory.edu. © 2019 International Anesthesia Research Society

Implementation of a Preoperative Anemia Clinic Utilizing a Minimal Staffing Model We present a process map for the implementation of a program to treat preoperative anemia utilizing 1 existing anesthesiologist in the preoperative evaluation clinic. In the first 7 months postimplementation, 342 patients were screened for anemia, 166 were diagnosed, and 107 were treated. The mean increase in hemoglobin in treated patients was ~2 g/dL (range 0–4.9 g/dL). Two patients’ surgeries were delayed in favor of treatment and 3 surgical patients, who had received 2 complete iron infusions, received an intraoperative transfusion. The total revenue generated for the institution was enough to subsidize the cost of an additional anesthesiologist. Accepted for publication October 3, 2019. Funding: This work was funded by the Department of Anesthesiology, Perioperative Care and Pain Medicine, New York University School of Medicine. The authors declare no conflicts of interest. Address correspondence to Jeanna D. Blitz, MD, Department of Anesthesiology, Perioperative Care and Pain Medicine, NYU Langone Health, 550 1st Ave, New York, NY 10016. Address e-mail to jeanna.viola@nyulangone.org. © 2019 International Anesthesia Research Society

Clevidipine-Induced Extreme Hypoxemia in a Neurosurgical Patient: A Case Report Clevidipine-induced pulmonary shunting is a little-reported adverse effect, manifesting as refractory hypoxemia, which may cause significant patient harm. We present the case of a mechanically ventilated patient admitted to the intensive care unit following a neurosurgical procedure. He was treated postoperatively with clevidipine for blood pressure management, and within 16 hours, he developed profound refractory hypoxemia, requiring increased ventilatory support. A workup for other causes was negative. The hypoxemia recovered within 1 hour of clevidipine discontinuation. Though other calcium channel blockers have been reported to cause pulmonary shunting from vasodilation, this is a novel case report for clevidipine-induced hypoxemia. Accepted for publication October 14, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Jack H. Short, MD, Department of Internal Medicine/Critical Care Medicine, Stanford University School of Medicine, Stanford, CA. Address e-mail to jhshort@stanford.edu. © 2019 International Anesthesia Research Society

Ventilation Failure due to Endotracheal Tube Migration Into a Tracheal Pouch in a Toddler With a Repaired Tracheoesophageal Fistula: A Case Report A tracheal pouch is a rare complication of successful repair of a congenital tracheoesophageal fistula (TEF). An 18-month-old child with a repaired congenital TEF was scheduled for esophageal dilation to treat his esophageal stricture. Migration of the distal end of the endotracheal tube into a previously undetected tracheal pouch caused an abrupt failure to ventilate at the end of surgery. Given our experience, we recommend to screen the trachea of every patient with corrected TEF for a tracheal pouch when they are scheduled for another procedure requiring general anesthesia. Accepted for publication October 16, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Vighnesh Ashok, FRCA, Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India. Address e-mail to vighneshmmc@gmail.com. © 2019 International Anesthesia Research Society

Repeated Intercostal Nerve Blocks With Liposomal Bupivacaine for Chronic Chest Pain: A Case Report No abstract available