A&A practice最新文献

This report aims to demonstrate the potential role of ultrasound-guided erector spinae plane block (ESPB) in managing refractory epigastric and chest pain due to vaso-occlusive crises (VOCs). An 18-year-old girl with sickle cell disease (SCD) presented to the emergency department with refractory epigastric and chest pain due to VOC. An ultrasound-guided left-sided erector spinae plane block (ESPB) using 30 mL of 0.2% ropivacaine provided rapid and sustained analgesia, reducing her Numerical Rating Scale (NRS) pain score from 8/10 at baseline to 0/10 at 2 hours postblock. She remained pain-free at 24 hours of follow-up and required no additional systemic opioids during a 48-hour inpatient observation period, suggesting ESPB feasible, opioid-sparing adjunct for thoracoabdominal VOC pain.

Patients with chronic limb-threatening ischemia (CLTI) who are not candidates for further revascularization frequently endure intractable pain, with major amputation often being the only remaining therapeutic option. We report 10 patients with severe peripheral arterial disease and nonreconstructable CLTI who underwent ultrasound-guided peripheral nerve stimulation (PNS) of the femoral and sciatic nerves for analgesia and possible limb preservation. Two avoided major amputation; eight underwent amputation a median of 33 days after implantation (interquartile range, 10-57.8). These preliminary findings suggest that PNS may provide pain relief and temporary prolongation of limb preservation in patients with advanced CLTI without revascularization options.

The Accreditation Council for Graduate Medical Education (ACGME) recommends competency-based residency curricula, but adherence varies. We piloted a standardized curriculum template for a pediatric anesthesiology rotation, separating didactic and skill-based goals, using checkboxes for progress monitoring, and organizing content by training level. Residents completed pre- and postintervention surveys and participated in a focus group. They reported low utilization of the curriculum due to limited awareness and unclear accountability. Interventions included formal introductions, improved access, and a checklist collection. Postintervention, residents reported increased curriculum awareness, use, and engagement. Findings support structured curricula paired with intentional implementation to enhance participation and learning.

Euglycemic diabetic ketoacidosis (EDKA) is associated with diabetes, alcohol use, pregnancy, and use of sodium-glucose cotransporter-2 (SGLT-2) inhibitors. Thus far, it has been described in the setting of cardiac surgery and a cohort of patients undergoing pancreaticoduodenectomy (Whipple) surgery. This case series is the first to describe the occurrence of perioperative euglycemic diabetic ketoacidosis in a cohort of nondiabetic patients not on SGLT-2 inhibitors undergoing hyperthermic intraperitoneal chemotherapy (HIPEC). We recommend measurement of ketones during or after surgery when EDKA is suspected to initiate therapy in a timely fashion.

Endotracheal intubation is crucial for maintaining airway patency and is frequently performed in critically ill patients. However, improper placement of the endotracheal tube (ETT), particularly concerning cuff position and inflation, can lead to significant complications. Bedside airway ultrasound offers a simple, noninvasive tool to evaluate ETT cuff position and mitigate the risks associated with overinflation or malposition. Existing literature describes the visualization of the cuff inflation point with a saline-filled cuff only. In this case report, we demonstrate how an air-inflated ETT cuff can be visualized using ultrasound and correlated with computed tomography (CT) imaging to confirm correct positioning. .

We report postoperative analgesia using multiple erector spinae plane block (ESPB) catheters in a patient undergoing single-stage surgery for synchronous breast and colon cancers. A 60-year-old woman underwent left mastectomy and laparoscopic right hemicolectomy. Three ESPB catheters (T4 left, bilateral T9) were placed after induction and maintained with programmed intermittent bolus ropivacaine. Analgesia was effective, opioid use was minimal, and early mobilization was achieved without block-related complications. Multicatheter ESPB may provide safe, effective thoracoabdominal analgesia within enhanced recovery after surgery (ERAS) pathways for complex synchronous procedures.

We report a case of a 48-year-old woman with schwannomatosis with chronic lower extremity pain that was refractory to surgical excision, interventional procedures, and medical management. Given that she had failed every typical treatment, it was decided that she would undergo spinal cord stimulation (SCS) for her neuropathic pain. After a successful percutaneous trial, the patient's permanent placement resulted in a near-complete and sustained pain elimination. Our case is an example that advanced interventional pain procedures, such as spinal cord stimulation, may have more indications than what is currently described, leading to innovations on how we might best serve our patients. .