A&A practice最新文献

Spondylocostal dysostosis (SCD) is an inherited skeleton growth disorder characterized by abnormalities of the vertebrae and ribs. Individuals are susceptible to kyphoscoliosis and pulmonary complications, which may be exacerbated by respiratory physiologic changes in pregnancy. We present a case of a parturient with severe kyphoscoliosis and restrictive lung disease who received a modified rapid sequence induction and transabdominal plane blocks for cesarean delivery. Our case describes the safe administration of general anesthesia for cesarean delivery and reviews the anesthetic considerations for managing patients with SCD.

This case series included 10 patients who underwent clavicular fracture surgery under general anesthesia. A novel analgesic approach combining 2 distinct nerve block techniques-serratus posterior superior intercostal plane block (SPSIPB) and clavipectoral plane block (CPPB)-was used for postoperative pain management. SPSIPB provided sensory blockade for the innervation of the clavicular skin, whereas CPPB targeted the clavipectoral fascia. The combination of SPSIPB and CPPB demonstrated variable efficacy in controlling postoperative pain. Future studies may explore potential improvements through dosage optimization, the use of adjuvants, or targeting higher anatomical levels.

Despite advancements in gender representation, female anesthesiologists continue to encounter challenges in career advancement that may be further impacted by motherhood. This scoping review examines personal and systemic barriers and facilitators to career advancement for anesthesiologists facing infertility, pregnancy, and childcare. The review identified 22 relevant studies across five themes: the timing of pregnancy and parental leave, breastfeeding and lactation needs, childcare and gender norms, job reentry and career advancement opportunities, and work-life balance and physician well-being. Recommendations from these studies include establishing clear parental leave policies, providing adequate lactation spaces and protected break times, addressing gender disparities in leadership roles, and prioritizing physician well-being. To implement these recommendations effectively, institutions and departments should develop and disseminate role-specific policies that promote career advancement and satisfaction through equitable support of pregnant and parent anesthesiologists.

Malignant hyperthermia (MH) is a potentially fatal disorder triggered by volatile anesthetics or succinylcholine, inducing a hypermetabolic crisis in susceptible patients. The caffeine-halothane contracture test (CHCT) remains a gold standard for MH detection. The authors describe a pregnant patient with a history of exertional rhabdomyolysis, who required urgent MH screening for administration of MH-triggering anesthetics. This anesthetic plan allowed for an in utero myelomeningocele repair for a 24-week-old fetus. A multi-institutional team coordinated the urgent CHCT and repair with a favorable outcome.

Transporting spontaneously ventilating adults with tracheostomies from the operating room (OR) or other anesthetizing locations to the intensive care unit (ICU) or other recovery locations presents significant challenges, as traditional T-pieces may not be readily available. This article describes a novel modification to the Ayre's T-piece, designed to address this gap by using readily available equipment. The modification integrates a 3-mL syringe, a size 7.0 endotracheal tube (ETT) connector, and oxygen tubing from an adult under-the-chin style facemask while adapting the expiratory and inspiratory limbs of the anesthesia circuit.

PHARC syndrome (polyneuropathy, hearing loss, ataxia, retinitis pigmentosa, and cataracts) is a rare autosomal recessive disease, caused by genetic mutation of the ABHD12 gene. This syndrome is still not well known and can be misdiagnosed, especially in the early stages, as it can be easily confused with other neurodegenerative diseases. We present the first description of the anesthetic management of 2 siblings with PHARC syndrome who underwent unilateral cochlear implantation.

Spread of drugs in the epidural space may be unpredictable. The differential diagnosis of unilateral hemiparesis could be due to the unilateral spread of the drug, spinal epidural hematoma, intraspinal hematoma, and spinal cord injury. Atypical distribution of local anesthetic can occur due to lateral displacement of the epidural catheter, patient positioning, or the presence of an epidural septum. We present a case of atypical spread of epidural local anesthetic causing hemiparesis. It emphasizes the need for careful monitoring of sensory levels on both sides and provides insight into the causes of unilateral drug spread in the epidural space.

Point-of-care ultrasound (POCUS) has established its role as a "third eye of a clinician" by virtue of its ability to provide real-time visual information. The present case highlights the role of POCUS in an 11-year-old girl with a misplaced hemodialysis catheter scheduled for surgical exploration with the removal of the catheter and direct arterial repair.