A&A practice
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Neonates with laryngeal webs pose unique challenges to the anesthesiologist. We present a 2-day-old neonate with aphonia and stridor who underwent microdirect laryngoscopy. Intraoperatively, a Cohen type 4 laryngeal web was diagnosed not immediately amenable to resection. ⋯ After endotracheal intubation, there was acute respiratory compromise and oxygen desaturation that improved moderately after urgent tracheostomy. A chest radiograph revealed a large pneumothorax. Our experience suggests that in the presence of high-grade laryngeal webs, the possibility of intraoperative development of pneumothorax should be considered if respiratory difficulties are encountered.
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Case Reports
Continuous Pectoral Fascia Blocks for Postoperative Analgesia After Median Sternotomy: A Case Report.
We report a novel case of a patient who presented for aortic valve replacement via median sternotomy. Bilateral continuous pectoral fascia blocks were placed to provide postoperative analgesia. Both numerical rating scale pain scores and opioid consumption after surgery were suggestive of analgesic benefit.
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Fluoroquinolones are a class of popular outpatient antimicrobial agents with a wide spectrum of therapeutic indications for respiratory and genitourinary infections. Though the most common side effects are gastrointestinal, fluoroquinolones have been increasingly associated with neurotoxicity including peripheral neuropathy and seizures. We present here a case of a 43-year-old woman with previously resolved type I complex regional pain syndrome (CRPS) who presented with symptoms of CRPS and neurotoxicity in the setting of levofloxacin administration. Our aim is to advocate for increased caution in prescribing to patients with a history of neuropathology including CRPS.
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Case Reports
It Is Not Always the Epidural: A Case Report of Anterior Spinal Artery Ischemia in a Trauma Patient.
Motor vehicle collisions impact millions of people annually resulting in multiinjury trauma. Anesthesiologists are consulted for rib fracture analgesia to improve respiratory mechanics and prevent intubation. ⋯ However, physical examination also indicated anterior spinal artery ischemia. Regional anesthesia and acute pain teams must be able to both identify contraindications and complications of regional techniques and discern when complications are not a result of regional interventions to initiate prompt management and definitive care.
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An increasing number of surgical procedures are performed in the ambulatory setting, leading to improved patient comfort and cost-effectiveness. Patients with suspected or known difficult airways represent a challenge when anesthetized. ⋯ We present 3 cases scheduled for day-case procedures with predicted difficult airways, where the feasibility of awake fiberoptic intubation is demonstrated in a Scandinavian fast track setting. Our hypothesis is that, with accurate preparations, intubation times are comparable with conventional intubation and that the procedure is associated with only minor patient discomfort.