A&A practice最新文献

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.

Takotsubo cardiomyopathy (TCM) is a reversible condition characterized by apical ballooning of the left ventricle, primarily triggered by catecholamine discharge due to stress. Patients may present with symptoms similar to acute coronary syndrome or with refractory ventricular arrhythmias such as QT prolongation, ventricular tachycardia, and ventricular fibrillation. We report a case of TCM with prolonged QT intervals and refractory ventricular arrhythmias, triggered by noncardiac systemic insult, that responded successfully to stellate ganglion block (SGB). This case highlights the potential of SGB as an effective intervention for managing refractory arrhythmias in TCM patients.

Thoracic epidural analgesia is commonly used for postoperative analgesia for abdominal and thoracic surgeries. One complication of thoracic epidural catheter placement is a malpositioned catheter, such as in the subarachnoid, subdural, or intrapleural space. We present a case of unintentional posterior mediastinal catheter placement. The catheter produced a sensory level and analgesic benefit and was only identified incidentally on computed tomography (CT) imaging. This case highlights another possible anatomic location for unintentional catheter placement, which may be more common than reported, as it functioned as an epidural catheter by all clinical metrics and would not have been identified without imaging.

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.