A&A practice最新文献

This case report highlights a unique instance of spinal myoclonus after neuraxial anesthesia. It aims to inform anesthesiology providers, enhancing their ability to identify, manage, and potentially prevent similar outcomes in patients at risk.

In conjoined twins when one of the twins is incompletely formed and is dependent on the healthy counterpart for survival, they are described as heteropagus (parasitic) twins. Rachipagus is a type of parasitic twin joined at the spine above the sacrum. Such neonates can present with complex problems related to anesthesia. We encountered one such infant for a routine contrast-enhanced computed tomography (CECT) angiography under sedation. The infant was resistant to multiple anesthetic drugs like fentanyl, propofol, and ketamine. Later general anesthesia was induced with thiopentone sodium, and the procedure went on uneventfully.

Caudal epidural catheters threaded to the thoracic levels are increasingly utilized in infants undergoing thoracic and abdominal surgery, compared to lumbar or thoracic epidural techniques. Estimating catheter length traditionally relies on anatomical landmarks, but the lack of spine ossification in infants makes ultrasonography a valuable and noninvasive tool. We present 3 cases where real-time ultrasonography facilitated caudal to thoracic epidural catheter placement in infants undergoing thoraco-abdominal surgeries. Incision-congruent placement of the catheter tip ensured effective perioperative analgesia with low doses of bupivacaine administered as intermittent boluses resulting in potent and prolonged analgesia with reduced opioid requirements.

Epidural steroid injections (ESI) are an effective nonsurgical option for the management of chronic lower back pain. Despite the increased frequency of ESI for low back pain management, there is a paucity in the literature surrounding systemic long-term effects. Reported adverse effects after fluoroscopically guided ESI with dexamethasone are low. This case report describes the development of anorgasmia in a 49-year-old man with chronic low back pain and bilateral leg radiculopathy, after a fluoroscopically guided L5/S1 interlaminar ESI with dexamethasone. This adverse effect highlights, to the best of our knowledge, the first documented case of anorgasmia after an ESI.

Among patients needing open abdominal surgery, those with high-risk medical conditions impose significant challenges from an anesthesia point of view. Thoracic continuous spinal anesthesia (TCSA) is an evolving technique that may be beneficial for a subset of patients with underlying high-risk medical conditions where general anesthesia (GA) becomes a relative contraindication. TCSA, as a primary anesthesia technique, is gaining favor for its advantages over GA in open abdominal surgery as it avoids airway intervention and mechanical ventilation. The current article focuses on TCSA in 2 patients at high risk for GA, which resulted in favorable perioperative outcomes.

Clavicle fractures are the most common fractures of the shoulder girdle. Due to the complex sensory innervation of the clavicle, patients' pain scores are high in the postoperative period. Therefore, multimodal regional analgesia techniques provided by the combination of cervical plexus and/or brachial plexus have been successfully applied in the literature. Serratus posterior superior intercostal plane block (SPSIPB) is a plane block that provides anterolateral chest wall analgesia. It provides analgesia between C3 and T10. In this case report, our experience with SPSIPB, which we applied for rescue analgesia in a patient who underwent surgery for a clavicle fracture, is described.

Hip disarticulation is a morbid procedure for those whose bony or soft tissues are unable to be salvaged. It involves extensive resection, and the patient featured in this report expressed mechanical pain from their sacroiliac joint (SIJ) as well as phantom limb pain (PLP). Spinal cord stimulation is known to assist with neuropathic pain syndromes, and SIJ fusion is effective in these cases of multifactorial pain. This report presents a successful off-label use of thoracic spinal cord stimulation in a complex pain condition consisting of coexisting PLP and mechanical SIJ pain in a hip disarticulation patient.

The off-label use of an intravenous dexmedetomidine infusion is an option for refractory symptoms in pediatric palliative care with a few published cases of in-home use, most limited to end-of-life care. After an intrathecal baclofen pump malfunction with meningitis and medication withdrawal, a 17-year-old adolescent with quadriparetic cerebral palsy and paroxysmal autonomic instability experienced relief of refractory pain and dystonia with an in-home intravenous dexmedetomidine infusion. His interdisciplinary care team collaborated to establish safety measures and adjust his home medication regimen to further improve quality of life well before his end of life.