A&A practice
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Tracheal extubation requires careful planning and preparation. We present the extubation of a patient with severe ankylosing spondylitis after cervical spine surgery. ⋯ We suggest preparing ECMO for rescue oxygenation when all other fundamental oxygenation techniques are predicted to be difficult or impossible. ECMO could be included in airway management and extubation guidelines.
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Pain management with opioids is often limited by medication side effects. One of the most common and distressing side effects is opioid-induced constipation (OIC), a syndrome that is now getting significant national attention. ⋯ Postoperatively, he developed OIC and Ogilvie syndrome, then following treatment with methylnaltrexone experienced an acute bowel perforation. We briefly review the recommended management of OIC as well as indications and contraindications of methylnaltrexone and similar new medications.
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The occurrence of a postdural puncture headache (PDPH) is a known risk associated with epidural procedures. The primary nonconservative treatment option for PDPH is the performance of an epidural blood patch. ⋯ A caudal catheter was placed under real-time guidance and visualization of the deposition of the blood was obtained. By entering via the caudal foramen and utilizing a catheter, manipulations in catheter placement could be performed to adjust deposition of the blood.
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Case Reports
Spinal Cord Stimulation as Treatment for Truncal Chronic Regional Pain Syndrome After Cardiac Surgery: A Case Report.
A 59-year-old man presented 7 months after coronary artery bypass with continued bilateral axillary pain. His symptoms progressed over a period of months to allodynia, edema, erythema, decreased range of motion, and skin changes consistent with complex regional pain syndrome type I. ⋯ Leads positioned in the posterior epidural space from the seventh cervical to the third thoracic vertebral levels resulted in complete paresthesia coverage of his truncal chronic regional pain syndrome (CRPS) and the stimulation was associated with almost complete resolution of CRPS. This case report suggests that spinal cord stimulation may provide effective treatment for truncal CRPS after coronary artery bypass graft surgery.
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Twitter is a social media platform that has been encouraged for use among anesthesiologists as a way to stimulate conversation, distribute research, enhance conference experiences, and expand journal club sessions. We aimed to establish the typical baseline use of hashtags that are not related to events such as conferences. ⋯ The most popular and relevant hashtags within anesthesia subspecialties or interest groups include #pedsanes, #anesJC, #OBanes, #intubation, #regionalanesthesia, #neuroanesthesia, and #cardiacanesthesia. We have identified the most popular anesthesia-related hashtags on Twitter to help anesthesiologists increase the reach and degree of discussions in anesthesia-related social media or twitter verse.