A&A practice最新文献

American Society of Regional Anesthesia and Pain Medicine guidelines recommend holding most antiplatelet therapy before inserting an epidural catheter; however, guidance for patients acutely initiated on antiplatelet therapy with a catheter in situ is limited. Here, we describe the management of 2 cases of patients with indwelling epidural catheters for pain management who developed acute myocardial infarctions necessitating emergent antiplatelet therapy. Established pharmacokinetics demonstrate maximal platelet inhibition occurs within 30 minutes in ticagrelor and 4 to 6 hours in clopidogrel, suggesting early removal results in decreased the risk of epidural hematoma.

The illicit use of the alpha-2 agonist animal tranquilizer xylazine ("tranq"), generally combined with fentanyl or heroin, has become an emerging health threat across the United States and Canada. We introduce a case showing the benefit of multidisciplinary management of a patient who presented for surgical management of xylazine-induced skin ulcers. In the perioperative period, maintenance of full-agonist opioids and alpha-2 agonists minimized the patient's withdrawal symptoms. A robust multimodal strategy, including the use of regional anesthesia catheters, when possible, helped limit opioid use in this highly tolerant patient while transitioning to long-term substance use treatment.

Pediatric neuropathic pain can be difficult to treat, may require a multimodal approach, and is often guided by adult literature given the paucity of pediatric studies. A healthy adolescent male presented with acute onset of severe bilateral lower extremity neuropathic pain diagnosed as erythromelalgia secondary to Lyme disease. After standard medication regimens failed to control his symptoms, popliteal nerve blocks improved pain control and subhypnotic doses of propofol provided significant pain relief. This case describes a complex multidisciplinary workup and multimodal treatment-including the successful use of subhypnotic propofol doses as an analgesic adjuvant for resistant pediatric neuropathic pain.

Background: Music can be used in the perioperative period as a nonpharmacological intervention to reduce anxiety, but how long it should be played to be effective is unknown. The goal of this study was to determine the 95% effective duration (ED95) of music of different subtypes for anxiolysis in parturients awaiting elective cesarean delivery. It was hypothesized that the overall ED95 would be <15 minutes and similar between music groups.

Methods: A prospective, randomized, biased coin study was conducted at a major academic institution. Consented parturients undergoing elective cesarean delivery were randomly assigned to one of 2 music groups: preselected Mozart sonatas or patient preference. Music duration began at 4 minutes and was subsequently increased, decreased, or kept the same based on the previous subject's response. Anxiety on a verbal scale of 0 to 10 and vital signs were compared pre-and postmusic. Successful intervention was defined as a decrease in anxiety by at least 1 point. Primary ED95 estimates with centered isotonic regressions (CIRs) were compared utilizing 83% confidence intervals (CI), while turning-point and simple means were compared with Student's t tests for sensitivity analysis.

Results: A total of 57 pregnant women were approached and 40 agreed to participate. The mean age was 33 (standard deviation [SD] 5.1). Primary ED95 estimates by CIR were 6.8 (83% CI, 5.9-8.4) minutes and 6.7 (83% CI, 5.9-8.3) minutes for Mozart and personal preference music, respectively. Mean ED95 by CIR for any music type was 6.8 minutes. Mean immediate postintervention anxiety reduction with Mozart music was 1.7 (SD 1.4) and personal preference was 2.6 (SD 2.0). There were no significant changes in heart rate or blood pressure immediately after music.

Conclusions: Playing music for <7 minutes is a versatile, effective, and low-risk method for anxiolysis in women awaiting elective cesarean delivery.

Opioid-free analgesia is crucial for high-risk patients, such as those with upper airway malignancies, to prevent respiratory complications. The Quadroiliac Plane Block (QIPB) offers an effective alternative. A 43-year-old female with base of tongue cancer underwent retrograde intrarenal surgery (RIRS) under spinal anesthesia. Postoperatively, a unilateral QIPB with 50 mg of 0.25% bupivacaine provided pain control. Pain levels, measured with the Numeric Rating Scale, decreased steadily over 24 hours without opioid use. QIPB effectively provided opioid-free analgesia for this high-risk patient, indicating its potential in perioperative pain management for similar cases.

The rarity of Huntington's disease (HD) parturients implies that anesthesiologists have little exposure to the management of these patients. We explore techniques for the management of a 21-year-old parturient with symptomatic HD who underwent successful neuraxial anesthesia for labor and subsequent cesarean delivery. We provide guidance on perioperative medications for comorbidities associated with HD. Dexmedetomidine, which we administered neuraxially, appears to have significant potential for the perioperative diminution of choreiform movements. Current anesthetic management of HD cannot be informed by traditional research methodology and therefore much information must be gleaned from the limited available case reports.