A&A practice最新文献

Suzetrigine is a unique, nonopioid oral analgesic that selectively inhibits voltage-gated sodium channels in peripheral nerves. The Food and Drug Administration (FDA) recently approved it, and we present the first successful use of suzetrigine in a 16-year-old boy with hereditary neuropathy who underwent foot reconstruction surgery. His postoperative pain management plan included a sciatic nerve catheter, a 14-day course of suzetrigine, opioids, and home medications. His pain was well controlled with no side effects. Within 24 hours of stopping suzetrigine, the patient's pain rapidly intensified, suggesting suzetrigine's effectiveness in postoperative pain management in an adolescent patient with neuropathy.

This study investigated whether artificial intelligence (AI)-based visual assistance in video laryngoscopy (VL) could be a solution to reduce the technique's learning curve. Twenty volunteers with no prior intubation experience were randomly assigned to 2 equal groups: standard VL or AI-enhanced VL (AI-VL). Participants performed 10 consecutive intubations. The AI-VL group showed a trend toward steeper learning curves for intubation time (P > .05). The AI system functioned as a real-time virtual instructor, which provided visual feedback that helped maintain Cormack-Lehane (C-L) views.

We present a case of a patient with multiple rib fractures who was managed in the intensive care unit using a serratus posterior superior intercostal plane (SPSIP) block. The SPSIP block is a relatively new interfascial plane block technique that provides broad thoracic dermatomal coverage for analgesia. In trauma patients with multiple rib fractures, pain control, preservation of respiratory function, prevention of pulmonary complications, and facilitation of early mobilization are important. This case suggests that the SPSIP block may represent a safe, effective, and opioid-sparing analgesic option in critically ill patients with thoracic trauma-related respiratory compromise and warrants further investigation.

Intraoperative ventilation in obese patients is challenging, eg, during robot-assisted surgery, where altered respiratory mechanics often require high levels of positive end-expiratory pressure (PEEP) and oxygen. With high intrathoracic pressures, hemodynamic instability may occur, while oxygenation can remain impaired. However, a gap of knowledge exists regarding the efficacy of flow-controlled ventilation (FCV) in patients with extreme obesity undergoing bariatric surgery. We describe an obese patient (body mass index [BMI] 68.6kg/m²) in whom conventional ventilation resulted in impaired oxygenation and respiratory compliance. FCV markedly improved gas exchange. Implementing FCV in high-risk obese patients may enhance gas exchange, limit ventilator-induced lung injury, and minimize hemodynamic compromise.

This case report highlights a novel and effective use of a combined erector spinae plane block (ESPB) and serratus posterior superior intercostal plane block (SPSIPB) as the primary anesthetic method for a patient undergoing scapula surgery who was at high risk for general anesthesia. The combination of these 2 fascial plane blocks successfully provided surgical anesthesia and postoperative analgesia while allowing the patient to remain awake and avoid the risks associated with mechanical ventilation. This technique represents a promising opioid-sparing strategy for the management of high-risk trauma patients.

Pain management after thoracotomy is particularly complex in lung transplant recipients on extracorporeal membrane oxygenation (ECMO), where anticoagulation significantly limits available treatment options. Coagulopathy constitutes a contraindication to neuraxial and deep peripheral nerve blocks due to hemorrhagic complications. Uncontrolled thoracotomy pain, hypoxia due to increasing opioid use, and hemodynamic instability can delay successful weaning from ECMO. We present the case of a patient on bivalirudin after undergoing a thoracotomy for a right lung transplantation. This case highlights the successful use of a serratus anterior plane block (SAPB) as an alternative approach to neuraxial anesthesia in an anticoagulated patient, optimizing analgesia and facilitating recovery postthoracotomy.

Awake flexible bronchoscopic (FB)-guided nasotracheal intubation is often necessary for managing difficult airways, especially in maxillofacial surgeries. We present 2 cases used a novel device for airway topicalization with a local anesthetic (LA) solution. This device integrates a nasal trumpet with a nebulization chamber to deliver 4% lidocaine, effectively anesthetizing the nasal cavity, nasopharynx, and the vocal cords. This technique was successfully used in 2 patients, ensuring smooth and efficient awake FB-guided nasotracheal intubation while minimizing adverse effects such as epistaxis, coughing, or discomfort.

A 41-year-old G2P1 underwent a vaginal delivery complicated by a retained placenta, uterine atony, and a massive postpartum hemorrhage of 4000 mL. Despite hypotension, care was not escalated, possibly due to the absence of tachycardia, pallor, or mental status changes. While maternal early warning criteria failed to trigger an alert, an electronic real-time surveillance platform activated a team response. The patient became unresponsive with a systolic blood pressure of 47 mm Hg and severe hypoxemia. Aortic compression restored consciousness. She was resuscitated with uncrossmatched blood and never-frozen plasma. Rotational thromboelastometry showed preserved coagulation. Automated alerts and rapid intervention were lifesaving.

This case report describes a novel ventilation method to safely accommodate robotic-assisted tracheobronchial surgery. The patient with a tracheal tumor 2.5 cm above the carina underwent a robotic-assisted tracheal resection. Single-lung jet ventilation was performed using the Monsoon Jet Ventilator during the tracheal resection and anastomosis. This allowed the surgeon to operate without interruption by eliminating an intermittent apneic technique. Through a small chest incision, the surgeon robotically advanced a Laserjet 40 tube into the transected end of the distal trachea. The endotracheal tube was directed into the left main bronchus and the patient was successfully managed with single-lung jet ventilation.

We present a case demonstrating the use of the rectointercostal fascial plane block (RICPB) for postoperative analgesia in a morbidly obese patient undergoing laparoscopic gastric bypass. RICPB was easily applied under ultrasound guidance and provided effective pain control with minimal opioid use. Its anterior approach offers technical advantages in obese patients where traditional blocks are challenging. Given its simplicity, dermatomal coverage, and favorable outcomes in our case, RICPB appears to be a promising in bariatric surgery and merits further investigation.