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

Painful Inguinal Angiomyomatous Hamartoma Responsive to Conservative Pain Management: A Case Report Angiomyomatous hamartoma (AMH) is a rare and benign mixed-tissue tumor of the lymphatic system. The majority of AMH tumors are removed surgically for cosmetic reasons or during workup of lymphadenopathy. There are few reported cases of this condition in the literature; AMH does not cause pain, and there are no published reports of AMH recurring after surgical excision. Here, we report a unique case of inguinal AMH recurring after surgical excision and causing a painful compression neuropathy. Our report also describes the patient’s successful but transient response to nonsurgical pain management. Accepted for publication June 25, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Christopher A. Woolley, MD, Department of Anesthesiology, University of California, 200 W Arbor Dr, #8770, San Diego, CA 92103. Address e-mail to cawoolley@ucsd.edu. © 2019 International Anesthesia Research Society

Intraoperative Placement of Paravertebral Catheters to Manage Postoperative Pain in Opioid-Dependent Patients After Thoracolumbar Spine Fusion Surgery: A Case Report We introduce a regional technique that involves the intraoperative placement of bilateral paravertebral catheters under direct visualization. The patient had stage IV lung cancer and was on chronic oxycodone therapy. He presented with a T10 metastatic lesion, and underwent spinal decompression with T7–L1 fusion and T10 corpectomy. Before fascial closure, catheters were advanced into the T10 paravertebral space under direct visualization by the surgeon bilaterally. Postoperatively, his pain was well controlled, and narcotic requirements were decreased. Our case report demonstrates that for patients undergoing posterior spine surgery, intraoperative placement of bilateral paravertebral catheters can be used to help manage postoperative pain. Accepted for publication June 17, 2019. Funding: None. The authors declare no conflicts of interest. The authors declare no conflicts of interest., Address correspondence to Kelly Y. Chen, MD, Department of Anesthesia, Critical Care, and Pain Medicine, Massachusetts General Hospital, 55 Fruit St, Gray-Bigelow 444, Boston, MA 02114. Address e-mail to kychen1@mgh.harvard.edu. © 2019 International Anesthesia Research Society

A Guide for Submitting a Manuscript That Is Aligned With the Mission of Anesthesia & Analgesia Practice Anesthesia & Analgesia (A&A) Practice is a journal for clinicians worldwide. It is aligned with the educational mission of its parent organization, the International Anesthesia Research Society. A&A Practice is an online-only companion journal of A&A. A&A Practice seeks to publish short yet informative, peer-reviewed, PubMed indexed articles that offer a solution to a perioperative care or patient safety conundrum or a health management issue, which is communicated as one of the several manuscript types. We herein provide authors with a guide to assist them toward a successfully published manuscript in A&A Practice. Accepted for publication June 5, 2019. Funding: None. Conflicts of Interest: See Disclosures at the end of the article. Address correspondence to BobbieJean Sweitzer, MD, FACP, Department of Anesthesiology, Northwestern University, Chicago, IL. Address e-mail to bobbiejean.sweitzer@nm.org. © 2019 International Anesthesia Research Society

Abdominal Surgery With Bilateral Rectus Sheath Block: A Case Report A 44-year-old man, American Society of Anesthesiologists physical status class IV, presented for fulguration of anal condyloma and diverting colostomy. The patient’s medical history includes World Health Organization (WHO) class I pulmonary hypertension (PH), right heart failure, and bilateral lower extremity paralysis due to Pott’s disease. The patient was not a candidate for neuraxial anesthesia due to sacral decubitus ulcers, and alternative options to general anesthesia (GA) were considered to avoid the high risk of right ventricular (RV) failure and ensuing complications. The case was successfully performed under sedation with dexmedetomidine infusion and bilateral rectus sheath blocks for surgical anesthesia. Accepted for publication May 16, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Elizabeth W. Duggan, MD, Department of Anesthesiology, Emory University Hospital, 1364 Clifton Rd, Office C-238, Atlanta, GA 30322. Address e-mail to ewdugga@emory.edu. © 2019 International Anesthesia Research Society

Neuropathic Pain due to Neurofibromatosis Treated With Transcutaneous Electrical Nerve Stimulation in a Pregnant Patient: A Case Report A patient with neurofibromatosis type 1 presented to the pain clinic with neuropathic pain. Thoracolumbar magnetic resonance imagining revealed meningocele T12–L2 with cauda equina distortion. After becoming pregnant, the patient interrupted opioid treatment, refusing pharmacological treatment until the pain became unbearable. Transcutaneous electrical nerve stimulation (TENS) was proposed. The patient used this treatment from the first trimester until month 6 postpartum, achieving good analgesia without any adverse effects for the mother or child. TENS may be a viable treatment for neuropathic pain (NP) during pregnancy. However, more data are needed due to the difficulty of conducting clinical trials in this population. Accepted for publication June 20, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Victor Caño Silva, MD, Department of Anesthesiology, Critical Care and Pain Clinics, L’Hospitalet de Llobregat, Av Feixa Llarga s/n, Barcelona 08907, Spain. Address e-mail to victorc@bellvitgehospital.cat. © 2019 International Anesthesia Research Society

Continuous Intravenous Lidocaine as an Effective Pain Adjunct for Opioid-Induced Bowel Dysfunction: A Case Report This case study describes a patient with suspected opioid-induced bowel dysfunction who had improved pain control when treated with intravenous (IV) lidocaine. An 80-year-old man with failed back surgery syndrome managed with an intrathecal (IT) pump presented with protracted abdominal pain. The acute pain service initiated a lidocaine infusion at 1 mg·min−1, and the patient reported significant pain relief. The patient experienced refractory abdominal pain with 3 attempts to wean the lidocaine infusion. Eventually, a successful transitional regimen was achieved with methylnaltrexone and transdermal lidocaine patches. Lidocaine infusions may be an effective and underutilized multimodal adjunct for nonsurgical pain conditions. Accepted for publication June 17, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Bryant W. Tran, MD, Department of Anesthesiology, Virginia Commonwealth University Medical Center, 1200 E Broad St, Box 980695, Richmond, VA 23298. Address e-mail to bryant.tran@vcuhealth.org. © 2019 International Anesthesia Research Society