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This case report describes a 49-year-old man who developed severe, atypical chest and shoulder pain mimicking myocardial ischemia after sclerotherapy for a hemangioma near the brachial plexus. Initial systemic analgesics were ineffective, and hemodynamic instability ensued. Suspecting acute neuralgia from sclerosant extravasation, an ultrasound-guided stellate ganglion block (SGB) was administered, resulting in rapid and sustained pain relief and stabilization. This case highlights a rare but significant complication of sclerotherapy and underscores the value of early interventional pain management. To our knowledge, this is the first report of SGB being used to treat acute neuralgia in this context.

Celiac artery compression syndrome (CACS) is characterized by chronic abdominal pain and gastrointestinal symptoms, which can be difficult to manage when the standard surgical intervention is contraindicated. This report details a case where spinal cord stimulation (SCS) was utilized as a palliative alternative for a patient with CACS, where surgical intervention was unsuitable. A successful 10-day SCS trial led to permanent SCS implantation, resulting in an 80% pain reduction and improved physical activity. As demonstrated by this case, the neuromodulation provided by SCS may have potential as a non-surgical option to enhance the quality of life for CACS patients.

Microbubbles during extracorporeal membrane oxygenation (ECMO) can cause systemic embolism. We report a 33-year-old woman in late pregnancy with COVID-19-associated myocarditis supported by veno-veno-arterial ECMO and Impella 5.5. During rapid transfusion via central venous catheter for massive hemorrhage after emergency cesarean section, transesophageal echocardiography (TEE) revealed microbubbles entering the arterial circulation. The bubbles resolved after pausing transfusion. Although the patient initially recovered without neurological deficits, she later died from unrelated intracranial hemorrhage. This case highlights the need to prevent air entrainment during transfusion and illustrates the diagnostic value of intraoperative TEE in detecting systemic microembolism under mechanical circulatory support.

Background: Large language models (LLMs) have the potential to automate time consuming clinical documentation tasks. One such task is generating ICU discharge summaries, which requires summarizing an often, complex clinical course and is time consuming. We compared the quality of LLM-generated ICU discharge summaries using expert intensivist evaluations. LLM summaries were assessed across six domains (coherence, consistency, fluency, relevance, utility, and overall quality relative to human-authored summaries) to determine their clinical suitability.

Methods: Ten patient cases were randomly selected from the MIMIC-III database. Each case included exactly 20 physician notes (progress, consultation, and admission notes). The Bidirectional and Auto-Regressive Transformer (BART) model generated individual note summaries that were then combined into comprehensive LLM-written discharge summaries. Four experienced intensivists scored LLM-generated summaries on a 5-point Likert scale across the six domains.

Results: LLM-generated summaries achieved median (IQR) scores of 4 (3-5) for coherence, 4 (3-5) for fluency, 3 (3-4) for consistency, 3 (2-4) for relevance, 3 (3-4) for utility, and 2 (2-3) for overall quality relative to human-authored summaries. Inter‑rater reliability was moderate for coherence (ICC = 0.62), consistency (0.65), and fluency (0.68), but lower for relevance (0.45) and utility (0.48). Although current LLMs were reasonably coherent, they frequently omitted patient‑specific information and scored lowest on utility, relevance and quality relative to human authored summaries.

Conclusions: LLMs can generate fluent and readable ICU discharge summaries but may overlook critical clinical details and lack depth compared to human-authored summaries. Further ICU-specific fine-tuning and incorporation of domain-specific knowledge are needed to improve LLM alignment with human expertise.

Childbirth-Related Posttraumatic Stress Disorder (CB-PTSD) can arise even after low-risk deliveries. This case report describes a 35-year-old woman who, despite a medically uncomplicated vaginal birth, developed severe CB-PTSD after being denied neuraxial analgesia and receiving remifentanil-PCA (remi-PCA) to manage pain. Her distress stemmed from inadequate pain relief, dissociation, and loss of control, exacerbated by unmet expectations for epidural analgesia. Five years later, she continues to process the trauma. This case underscores the importance of informed consent, patient-centered analgesia, and trauma-aware maternity care. Addressing modifiable risk factors and providing early psychological support may reduce CB-PTSD prevalence and improve maternal well-being.

A 48-year-old man with a superior labral tear and medical history including hemidiaphragmatic paresis, obstructive sleep apnea, vocal cord paresis, and glottic narrowing, underwent arthroscopic biceps tenodesis. Reduction in respiratory function presented anesthetic management challenges with general anesthesia or an interscalene brachial plexus block. Instead, ultrasound guidance was used to deliver a selective upper-trunk block with 1 % lidocaine and an axillary nerve block with 0.5 % ropivacaine. Immediately before incision, the surgeon administered 1 % lidocaine for LIA at the arthroscopic portal sites and within the shoulder capsule. The procedure was completed successfully with the patient awake and comfortable.

After significant damage to an intravenous fluid manufacturing plant during Hurricane Helene, fluid conservation was necessary, and many healthcare institutions delayed elective procedures to safeguard fluids. We present a perioperative intravenous fluid conservation strategy initiated at one tertiary care institution in response, and specifically reviewed 5 different perioperative sites with predominantly outpatient cases. Perioperative fluid conservation led to an overall 68% reduction in intravenous fluid utilization in one month. Compared with the 3 prior months, rates of intraoperative hemodynamic instability, postoperative nausea and vomiting, and recovery times were similar.

Background: To train and encourage providers to be more empathic, it is crucial to first understand what behaviors providers consider acts of empathy in clinical practice. Research has asked this important question of patients and certain physician specialties, but has left out a unique physician population-anesthesiologists. Given the link between patients' preoperative anxiety and poorer postoperative outcomes, anesthesiologists' ability to address patients' needs effectively, particularly during shorter interactions with new patients, may impact patient outcomes. The purpose of the current research was to investigate what anesthesiologists consider to be empathic behaviors and to compare these results with past investigations of other physician specialties.

Methods: Practicing anesthesiologists (N = 99) were recruited online to rate 49 physician behaviors on a 0 to 10 scale for the degree to which each behavior was aligned with their own conceptualization of clinical empathy.

Results: Three components of empathic behaviors emerged: Conscientious and Reassuring, Relationship Oriented, and Emotionally Involved. In line with past work with other physician specialties, anesthesiologists rated Relationship-Oriented behaviors as those most closely related and Conscientious and Reassuring behaviors as least closely related to what they viewed as empathy. Although not statistically significantly, men anesthesiologists were more likely to view Conscientious and Reassuring behaviors as aligned with their conceptualizations of empathy than women anesthesiologists, and women anesthesiologists were significantly more likely to view Emotionally Involved behaviors as aligned with their conceptualizations of empathy than men anesthesiologists, with medium effect sizes.

Conclusions: Although anesthesiologists interact with patients during some of the most emotionally charged and vulnerable situations when evaluating, monitoring, and supervising patient care, beginning preoperatively and continuing through their postoperative care, they do not view empathy behaviors fundamentally differently than other physician specialties. We discuss how these results can inform medical education communication and relational approaches by capitalizing on the understanding of anesthesiologists' conceptualizations of empathy.