A&A Practice

Successful Verbal Communication Using Google Translate to Facilitate Awake Intubation of a Patient With a Language Barrier: A Case Report Perioperative difficult airway management is one of the most challenging tasks encountered by anesthesiologists. Awake intubation is considered the gold standard in securing the anticipated difficult airway. Effective communication between the anesthesiologist and patient is vital during awake intubation. A language barrier can significantly hinder success and jeopardize patient safety. We report a case of a monolingual Arabic-speaking patient with a difficult airway who required awake intubation to undergo surgery. Google Translate, a free and accessible translation software application, was used during his awake intubation—we recommend such an approach to be considered to reduce anxiety and facilitate success by providing concise, real-time instruction in the patient’s preferred language. Accepted for publication November 25, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Ravish Kapoor, MD, 1400 Holcombe Blvd, Unit #409, Houston, TX 77030. Address e-mail to rkapoor@mdanderson.org. © 2019 International Anesthesia Research Society

Successful Use of High-Flow Nasal Cannula for Concurrent Vocal Cord Electromyography and Tubeless Microlaryngeal Surgery in a Spontaneously Breathing Adult Patient: A Case Report Ventilation during microlaryngoscopy previously included jet ventilation, microlaryngeal endotracheal tubes, and extended apnea. Historically, apneic oxygenation provided a tubeless field but limited operative time. Increased utilization of high-flow nasal cannula in intensive care units and operating rooms has created new opportunities to expand tubeless microlaryngoscopy. Although few studies have described high-flow nasal cannula for microlaryngoscopy, there remains much to be explored. In this case report, we describe the unique setting of utilizing high-flow nasal cannula in a spontaneously breathing patient to create an optimal tubeless surgical field for both microlaryngoscopy and vocal cord electromyography. Accepted for publication November 14, 2019. Funding: None. The authors declare no conflicts of interest. Institutional review board: This study received Partners IRB approval. Protocol No.: 2019P000353. Address correspondence to Jeremy Juang, MD, PhD, Department of Anesthesiology, Massachusetts Eye and Ear, 243 Charles St, Boston, MA 02114. Address e-mail to jeremy_juang@meei.harvard.edu. © 2019 International Anesthesia Research Society

Anesthetic Management of an Adult Patient With Hyaline Fibromatosis Syndrome Undergoing Laparoscopic Colectomy: A Case Report Hyaline fibromatosis syndrome (HFS) is a rare autosomal recessive disorder characterized by hyaline fibrous depositions in the skin and internal organs. Contractured joints and gingival hypertrophy make airway management difficult in patients with HFS, while trunk deformities complicate surgical positioning. A 56-year-old woman with HFS underwent laparoscopic colectomy for sigmoid colon cancer. Her airway was secured by awake fiberoptic intubation, and general anesthesia was maintained uneventfully. This report discusses the oldest reported patient with HFS and is the first to describe the management of epidural anesthesia in a patient with HFS. Accepted for publication November 15, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Mizuki Yoshikawa, MD, Department of Anesthesia, Japanese Red Cross Otsu Hospital, 1-1-35, Nagara, Otsu, Shiga 520-8511, Japan. Address e-mail to mizuki.yskw@gmail.com. © 2019 International Anesthesia Research Society

Lund University Cardiac Assist System Induced Liver Laceration and Anterior Cord Infarction After Cardiac Arrest: A Case Report We describe a hepatic laceration and subsequent anterior spinal artery syndrome in a 21-year-old man, secondary to prolonged cardiopulmonary resuscitation with a Lund University Cardiac Assist System (LUCAS2) mechanical cardiac compression device. We briefly review the current literature pertaining to hepatic injury from trauma due to cardiopulmonary resuscitation. The etiology of the anterior spinal artery syndrome in this patient is discussed. This case highlights that intra-abdominal causes of hypotension should be considered in patients after a prolonged resuscitation attempt. Extending focused cardiac ultrasound to exclude intra-abdominal free fluid should be routinely considered in these patients. Accepted for publication November 4, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Thomas Drew, MD, Department of Anesthesia and Pain Management, Mount Sinai Hospital, 600 University Ave, Toronto, ON M5G 1X5, Canada. Address e-mail to drthomasdrew@gmail.com. © 2019 International Anesthesia Research Society

An Unusual Cause of Intraoperative Hemodynamic Instability Complicating Elective Mastectomy With Immediate Free Flap Reconstruction: A Case Report Extrinsic compression of the heart consequent to intrapleural fluid is a rare cause of cardiac tamponade. Cases of massive hemothorax resulting in external cardiac tamponade due to injury of the internal thoracic artery (ITA) following blunt or penetrating trauma have been described in the literature. Here, we present a case of iatrogenic injury to the right ITA complicating mastectomy and deep inferior epigastric perforator flap reconstruction. It manifested as hemodynamic instability that persisted despite aggressive fluid resuscitation. Investigation with an intraoperative transesophageal echocardiogram demonstrated cardiac tamponade secondary to a massive hemothorax which resolved following surgical placement of an intercostal drain. Accepted for publication November 20, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Bruce Young, FRCA, Department of Anaesthetics, Guy’s and St Thomas’ NHS Foundation Trust, Westminster Bridge Rd, London, SE1 7EH, United Kingdom. Address e-mail to bruce.young1@nhs.net. © 2019 International Anesthesia Research Society

Airway Obstruction Caused by Hemorrhage: Managing a Life-Threatening Complication in Patients With Acquired Hemophilia A: A Case Report A 60-year-old woman presented with extensive swelling in the throat and impending airway obstruction. Following a well-established 2-step flexible bronchoscopic intubation procedure, a computed tomography scan identified a large hematoma compromising the airway. Laboratory testing confirmed the diagnosis of acquired hemophilia A (AHA), a rare condition that can potentially be life-threatening, particularly when it results in airway obstruction. The risk of fatal bleeding is substantial when difficult airway management guidelines call for a surgical airway. This case report describes the essentials of hemostatic treatment of AHA and our approach to the management of a difficult airway. Accepted for publication November 14, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Susann Endermann, MD, Division of Anesthesiology, Intensive Care, Rescue and Pain Medicine, Kantonsspital St. Gallen, St. Gallen 9007, Switzerland. Address e-mail to susann.endermann@kssg.ch. © 2019 International Anesthesia Research Society

In Response No abstract available

Longitudinal Competency-Based Point-of-Care Ultrasound Curriculum in Anesthesiology: Description and Initial Experience With PGY1 and PGY2 Trainees Point-of-care ultrasound is becoming increasingly utilized in centers throughout the country for use in perioperative regional anesthesia procedures, vascular access, diagnosis, and resuscitation. We propose an educational approach that not only spans the 4-year duration of anesthesia residency but also regularly assesses progress throughout training. We accomplish this through a flipped classroom model, in which the 12 residents in each class participate in online modules for the baseline didactic knowledge, then come to a session where they have the opportunity to work in small groups (1:2–1:3 ratio of faculty to learner) and practice the skills outlined in the modules. Accepted for publication October 18, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Megan M. Rashid, MD, Department of Anesthesiology, Virginia Commonwealth University Health System, PO Box 980695, Richmond, VA, 23298. Address e-mail to megan.rashid@vcuhealth.org. © 2019 International Anesthesia Research Society

Successful Airway and Anesthesia Management Using a High-Flow Nasal Cannula in a Fibrodysplasia Ossificans Progressiva Patient During General Anesthesia: A Case Report Fibrodysplasia ossificans progressiva (FOP) is a rare hereditary disorder causing neck stiffness, ankylosis of temporomandibular joints, and severe restrictive respiratory dysfunction due to progressive heterotopic ossification of the connective tissue. Herein, we report a case of successful airway and anesthesia management using a high-flow nasal cannula (HFNC) in a 51-year-old man with FOP undergoing partial bone resection of the right greater trochanter of the femur. Although general anesthesia with awake fiberoptic nasotracheal intubation has been described as the gold standard, HFNC may yield another potentially viable option for patients undergoing a surgical procedure that does not involve the airway. Accepted for publication November 4, 2019. Funding: None. The authors declare no conflicts of interest. Address correspondence to Hiroyuki Seki, MD, PhD, Department of Anesthesiology, Tokyo Dental College Ichikawa General Hospital, Sugano 5-11-13, Ichikawa Chiba 272-8513, Japan. Address e-mail to hseki@tdc.ac.jp. © 2019 International Anesthesia Research Society

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