A&A practice最新文献

We report the anesthetic management of a 10-year-old girl with treatment-refractory, acetylcholine receptor antibody-positive juvenile myasthenia gravis (JMG) undergoing minimally invasive thymectomy after a recent myasthenic crisis. Anesthetic planning focused on avoiding neuromuscular blockers, minimizing stress, and preserving respiratory function. Paravertebral blocks with intercostal cryoablation provided postoperative analgesia-an approach not previously reported in pediatric JMG. This case illustrates the complexity of anesthetic care in JMG and the value of individualized, multidisciplinary planning to ensure safe and effective minimally invasive thymectomy in children. .

Background: Patients with endometriosis undergoing surgery are at risk of moderate-to-severe postoperative pain. Clonidine, an alpha-2 agonist with analgesic properties, may improve multimodal pain management in these patients.

Methods: We conducted a randomized, blinded, placebo-controlled trial to investigate the effect of a single intraoperative dose of clonidine on postoperative opioid consumption and pain intensity. Patients undergoing endometriosis surgery at Aarhus University Hospital, Denmark, were randomized 1:1 to receive either intravenous clonidine (150 µg) or placebo intraoperatively. Our primary outcome was cumulative opioid consumption (intravenous morphine equivalents) 3 hours after surgery. Secondary outcomes included opioid consumption at 6 hours, pain intensity at rest and during coughing, shivering, postoperative nausea and vomiting, and sedation within the first 2 postoperative hours. The length of stay in the postanesthesia care unit was also recorded.

Results: A total of 120 women (mean ± standard deviation [SD] age 37 ± 7 years) were included in the final analysis, with 57 receiving clonidine and 63 receiving placebo. Mean (interquartile range [IQR]) postoperative intravenous morphine consumption during the first 3 hours was lower in the clonidine group with 5 mg (0-10) compared to 10 mg (0-16.5) in the placebo group (P = .032). Shivering was less frequent in the clonidine group (3 vs 18 patients, P = .001). Sedation was more common in the clonidine group (21 vs 12 patients, P = .029). No differences were found between groups for pain intensity at rest and during coughing, postoperative nausea and vomiting, or length of stay in the postanesthesia care unit (PACU).

Conclusions: A single intraoperative dose of clonidine is hemodynamically safe in patients undergoing endometriosis surgery and is associated with reduced postoperative opioid consumption and shivering, but increased sedation.

Chronic pain is a common and disabling feature of mast cell activation syndrome (MCAS), with no established treatment paradigm. Cannabidiol (CBD) has recently shown potential to suppress mast cell activation and degranulation. We present a unique case in which widespread, severe, refractory MCAS-related pain was treated with a combination of orphenadrine and CBD oil. Marked improvements were observed at 4 and 20 weeks posttreatment, with pain severity and interference scores reduced by 56% and 87%, respectively. This therapeutic combination may represent a promising new adjuvant approach for managing pain in MCAS and warrants further investigation. .

Untreated hyperthyroidism can lead to thyroid storm, a medical emergency with high mortality. This case report discusses a patient with untreated hyperthyroidism undergoing evaluation before elective resection of a mediastinal mass in the preoperative anesthesia setting. The preoperative anesthesia provider's systematic assessment and timely endocrinology referral with subsequent management of the thyroid disease shifted the trajectory of the patient's treatment, and ultimately prevented an unnecessary, invasive surgical procedure. The value of advanced practice providers in the preoperative anesthesiology clinic setting is highlighted.

Intraoperative neuromonitoring (IONM) involves repeated electrical stimulation of the nervous system to assess integrity of neural pathways. Transcranial motor evoked potentials (tcMEPs) require high levels of electrical stimulation and are not recommended for patients with neurologic stimulators in situ, such as a deep brain stimulator (DBS) system, due to the risk of device damage and patient harm. We describe a case of a patient with bilateral DBS undergoing a surgery with IONM, in which direct electrical response wave (D-wave) monitoring via an epidural electrode was used, rather than tcMEPs, to monitor the motor tracts while protecting and preserving the DBS.

The sacral erector spinae plane (ESP) block, performed by injecting local anesthetic deep to the sacral multifidus, may spread cephalad to lumbar levels and anteriorly to sacral roots. We report an 88-year-old patient undergoing hip fracture surgery in whom a sacral ESP block was performed at S1, injecting 20 mL 0.2% ropivacaine with 20 mL iomeprol (300 mg·mL⁻¹). Computed tomography (CT) scan at 120 minutes showed spread to L2, involving L4-L5 and S2-S3 roots and possibly the sciatic nerve. Analgesia was effective with only paracetamol for 48 hours. Further imaging and anatomical studies are warranted.