A&A practice
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We report a rare case of iatrogenic arterial cannula transection during a dressing change and migration of the distal fragment within the radial artery. The retained intraarterial fragment was successfully located using ultrasound, enabling swift surgical removal. We discuss the risk factors associated with arterial cannula transection and the efficacy of imaging modalities in locating the intraarterial fragment.
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Anaphylaxis occurs in 1/5000-1/20,000 of anesthesia cases and may evolve with shock and cardiovascular collapse in up to 54% of cases. Mortality varies from 3% to 10%. ⋯ Exaggerated activation of the nitric oxide-cyclic guanosine monophosphate pathway is observed in refractory shock. Methylene blue selectively inhibits this pathway.
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Placement of Stimulating Epidural Catheter for a Patient With Large Scapular Sarcoma: A Case Report.
We report the use of continuous electrical stimulation to assist with the preoperative placement of a thoracic epidural which was used to provide postoperative analgesia in a patient undergoing excision of a large scapular sarcoma. The size of the sarcoma and the surrounding area required to maintain a sterile surgical field necessitated that the epidural catheter be inserted several vertebral interspaces caudal to the level of desired catheter tip termination. The use of electrical stimulation allowed for sequential intercostal muscle stimulation during threading, which enabled the placement of the catheter tip at the appropriate spinal level to optimize analgesia.