A&A practice
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Chronic neck and upper back pain occurs in 40%-60% of patients that suffer whiplash injury. Increasing evidence points to a dysfunction of the cervical and thoracic muscles as the predominant cause of persistent pain in this cohort. ⋯ As a result, there is significant functional impairment leading to excessive health care costs. The authors present a novel treatment, intermediate cervical plexus block with depot steroids, in 3 patients presenting with refractory chronic neck and upper back pain from whiplash injury that produced durable analgesia and enabled return to employment.
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Methyl CpG binding protein 2 (MECP2) duplication syndrome is a rare X-linked genetic disease. Core phenotypes include infantile hypotonia, developmental delay, and minimal speech with mild dysmorphic features. Many have refractory epilepsy and recurrent infections, which are the leading causes of mortality. This article presents a case of a patient with MECP2 duplication syndrome who required general anesthesia for respiratory workup and reviews the anesthetic management for these patients, which includes induction technique, choice of drugs, and other major anesthetic concerns.
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Spinal muscular atrophy (SMA) is an autosomal recessive condition characterized by degeneration of the anterior horn cells of the spinal cord, which causes progressive muscle atrophy and weakness. SMA type 1 is the most common type and is associated with severe disability and early mortality. Concomitant restrictive respiratory physiology often manifests with significant implications for anesthetic management. Here, we describe a successful spinal anesthetic for orthopedic surgery in an SMA type 1 patient receiving intrathecal nusinersen maintenance therapy, an antisense oligonucleotide designed to increase expression of the survival motor neuron protein, and the first US Food and Drug Administration-approved drug to treat SMA.
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Awake endotracheal intubation is the technique of choice to secure the airway when both mask ventilation and intubation are anticipated to be difficult. We present a case of a patient with a known difficult airway, bronchopleural fistula (BPF), and acute respiratory distress syndrome (ARDS) who was intubated with a double-lumen endotracheal tube (DL ETT) under awake condition using a videolaryngoscope. ⋯ The patient was treated successfully for ARDS and discharged home. To our knowledge, this is the first reported case of successful videolaryngoscope-assisted DL ETT intubation in an awake patient.
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Case Reports
Transesophageal Echocardiography-Guided Cardiopulmonary Resuscitation After Rocuronium Anaphylaxis.
Anaphylaxis is a life-threatening hypersensitivity reaction that can quickly progress to circulatory collapse, even in the presence of timely epinephrine administration. This report describes a case of rocuronium anaphylaxis which progressed to circulatory arrest despite intravenous epinephrine and crystalloid resuscitation. Transesophageal echocardiography performed during cardiopulmonary resuscitation enabled rapid identification of the cause of shock and redirected management to prioritize further fluid administration, leading to return of spontaneous circulation with a good outcome. The etiology of shock in anaphylaxis can be variable, and transesophageal echocardiography can rapidly identify the likely mechanism and guide treatment without interrupting ongoing resuscitative efforts.