A&A practice
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Case Reports
Catastrophic Intracardiac Thrombosis During Emergency Repair of an Expanding Aortic Pseudoaneurysm: A Case Report.
Catastrophic thrombosis is a rare but frequently fatal event following complex cardiac surgery. It is most often encountered following separation from cardiopulmonary bypass (CPB) and reversal of heparin anticoagulation, and somewhat paradoxically, at the time when bleeding from post-CPB coagulopathy is being treated. ⋯ Following a prolonged operation, she developed intracardiac thrombus during transfusion of hemostatic blood products and procoagulant agents. Potential contributing factors are discussed.
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The Ventrain is a small, manually operated, single-use, inspiratory flow-adjustable ventilation device that generates positive pressure during inspiration and, through a Bernoulli effect within the device, active suction during expiration. It was designed to provide emergency ventilation during airway obstruction via narrow-bore cannulae. ⋯ It remains to be seen if its theoretical advantages in "can't intubate, can't oxygenate" (CICO) scenarios translate to reliable clinical benefit and allow inclusion in future airway algorithms. We advocate for regular simulation training and the detailed reporting of clinical experience with this encouraging new tool.
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Hepatopancreaticobiliary (HPB) surgery is major upper abdominal surgery with considerable risk of pulmonary complications related to postoperative pain. While epidural analgesia remains an effective analgesic technique for upper abdominal surgery, HPB surgery poses challenges to its use due to coagulopathy. ⋯ Injection of local anesthetic deep to the erector spinae muscle plane and placement of a catheter for prolonged effect provide both somatic and visceral analgesia for both thoracic and abdominal surgery. We describe a series of 3 cases that illustrate the efficacy of ESP blocks after major HPB surgery.
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A patient with neurofibromatosis type 1 presented to the pain clinic with neuropathic pain. Thoracolumbar magnetic resonance imagining revealed meningocele T12-L2 with cauda equina distortion. After becoming pregnant, the patient interrupted opioid treatment, refusing pharmacological treatment until the pain became unbearable. ⋯ The patient used this treatment from the first trimester until month 6 postpartum, achieving good analgesia without any adverse effects for the mother or child. TENS may be a viable treatment for neuropathic pain (NP) during pregnancy. However, more data are needed due to the difficulty of conducting clinical trials in this population.
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The main purported benefit of suture-style catheters is the ability to secure the catheter at 2 sites, thereby decreasing the likelihood of catheter dislodgement. An additional benefit is the ability to precisely control the placement of the orifice to infuse local anesthetic. ⋯ Despite multiple attempts, the catheter repeatedly advanced beyond the nerve. Placement of a suture catheter was then attempted, and the catheter was successfully placed on the first attempt.