Incidence of Thromboembolic Events in Oncology Patients Receiving Intraoperative Tranexamic Acid During Orthopedic Surgery: A Retrospective Review at a Comprehensive Cancer Center Despite an abundance of evidence, routine perioperative antifibrinolytics have been avoided in oncology patients due to concern of thrombosis when given to patients with a preexisting hypercoagulable state. We present a retrospective review of 104 patients with an oncologic diagnosis who received intraoperative tranexamic acid during orthopedic surgery. Overall, complication rates were low, including deep vein thrombosis (1.0%), pulmonary embolism (4.8%), stroke (0%), and myocardial infarction (0%). This preliminary evidence shows that antifibrinolytics such as tranexamic acid may be considered perioperatively in oncology patients without increased risk of thromboembolic events; however, further prospective trials are encouraged. Accepted for publication September 27, 2019. The authors declare no conflicts of interest. Funding: None. Address correspondence to Sephalie Y. Patel, MD, Department of Anesthesiology, H. Lee Moffitt Cancer Center, 12902 Magnolia Dr, Tampa, FL 33606. Address e-mail to sephalie.patel@moffitt.org. © 2019 International Anesthesia Research Society

Use of Virtual Reality as a Surrogate for Parental Presence During Anesthetic Induction: A Case Report Virtual reality (VR), a computer-generated simulation of a 3-dimensional environment, is a relatively new method of providing distraction before and during procedures. We describe the use of a VR multiuser application, Oculus Rooms, to calm an anxious 10-year-old boy during transportation to the operating room and induction of anesthesia. The use of VR could lessen the perioperative anxiety of children by maintaining a virtual child-parent connection while avoiding the potential drawbacks to having parents actually in the operating room before and during induction of anesthesia. The success of this novel technique has important implications for future clinical trials and practice. Accepted for publication September 10, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Abhinav Gupta, MD, Department of Anesthesiology, University of Colorado School of Medicine, Children’s Hospital Colorado, 13123 E 16th St, P O Box 090, Aurora, CO 80045. Address e-mail to abhinav.gupta1230@gmail.com. © 2019 International Anesthesia Research Society

Greater Occipital Nerve Block as a Tool to Diagnose Spontaneous Intracranial Hypotension Before Epidural Blood Patch: A Case Report Spontaneous intracranial hypotension (SIH) has been increasingly characterized in recent years. A definitive diagnostic algorithm remains controversial because several symptoms are often found to be nonspecific. When neuroimaging fails to identify a cerebrospinal fluid leak and symptoms are atypical, an epidural blood patch (EBP) may be performed but not without risks. Our case shows how greater occipital nerve block (GONB) can expedite SIH diagnosis in a man with atypical presentation by reducing the sensory input from the posterior cranial fossa. The relief provided by GONB allowed to diagnose SIH promptly and the patient underwent a curative EBP. Accepted for publication September 23, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Andrea Bortolato, MD, Neurointensive Care Unit, University Hospital of Padova, Via Giustiniani 2, 35128 Padova, Italy. Address e-mail to freeandrea.b@libero.it. © 2019 International Anesthesia Research Society

Severe and Prolonged Hypotension After Oral 5-Aminolevulinic Acid Administration in a Patient With End-Stage Renal Disease Undergoing Transurethral Resection of a Bladder Tumor: A Case Report A 72-year-old man with end-stage renal disease (ESRD) undergoing transurethral resection of a bladder tumor experienced severe and prolonged hypotension after receiving oral 5-aminolevulinic acid (5-ALA). Continuous infusions of norepinephrine and vasopressin ultimately resolved the hypotension over the course of 26 hours. It is uncertain whether 5-ALA is causative or is a contributing factor that influences other factors, such as hypovolemia after hemodialysis and autonomic nerve dysfunction associated with ESRD. Our findings suggest that anesthesiologists should be aware of the possible occurrence of hypotension after administration of 5-ALA, and urologists should consider intravesical 5-ALA administration in patients with ESRD. Accepted for publication September 30, 2019. The authors declare no conflicts of interest. Finding: None. Address correspondence to Tatsuya Kida, MD, Department of Anesthesiology, Yokosuka Kyosai Hospital, 1-16 Yonegahamadori, Yokosuka, Kanagawa 238-8558, Japan. Address e-mail to bcvn400dd@gmail.com. © 2019 International Anesthesia Research Society

Andexanet Alfa Use in Patients Requiring Cardiopulmonary Bypass: Quo Vadis? No abstract available

The Use of Liposomal Bupivacaine in Erector Spinae Plane Block to Minimize Opioid Consumption for Breast Surgery: A Case Report: Erratum No abstract available

Bradycardic Arrest During Somatosensory-Evoked Potential Monitoring: A Case Report Intraoperative neurophysiological monitoring involves electrical stimulation of nerve pathways and is used to assess the integrity of both motor and sensory pathways. Whereas motor pathway monitoring involves transcranial stimulation and peripheral nerve monitoring, somatosensory monitoring involves peripheral nerve stimulation and cranial monitoring. Arrhythmias are a known complication of motor-evoked potential monitoring but have not been reported with somatosensory monitoring. We describe a case of bradycardic arrest with somatosensory-evoked potential monitoring using median nerve electrodes in a patient with no previous rhythm abnormality. Clinicians caring for patients receiving somatosensory monitoring should be aware of the potential for severe arrhythmias. Accepted for publication September 23, 2019. Funding: This study was supported by the Department of Anesthesia and Critical Care at the University of Chicago. Conflicts of Interest: See Disclosures at the end of the article. Address correspondence to Jacqueline Morano, MD, Department of Anesthesia and Critical Care, University of Chicago, 5841 S Maryland Ave, MC 4028, Chicago, IL 60637. Address e-mail to jmorano1@dacc.uchicago.edu. © 2019 International Anesthesia Research Society

Subdural Displacement of an Epidural Catheter With Spinal Cord Compression in a Patient With Chronic Cancer Pain: A Case Report Here we present the case of a 76-year-old woman with pancreatic cancer receiving epidural analgesia for chronic cancer pain treatment. Attempts of running the epidural catheter sequentially resulted in unexpected and extensive sensory block together with sympathicolysis but insufficient pain control. Finally, after 3 failed attempts of epidural catheter placements with insufficient pain control and uncommon neurological signs, a magnetic resonance imaging (MRI) scan of the spine was ordered. The MRI showed subdural catheter displacement with extensive liquid accumulation in the subdural space and consequent significant spinal cord compression. Findings normalized after removing the subdural catheter. Accepted for publication September 23, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Michael T. Ganter, MD, Institute of Anesthesiology, Brauerstrasse 15, 8401 Winterthur, Switzerland. Address e-mail to michael.ganter@ksw.ch. © 2019 International Anesthesia Research Society

Echocardiographic Assessment of Ventricular Septal Defects No abstract available