A&A practice
-
Case Reports
Airway Management Through a Facial Defect Resulting From Noma (Orofacial Gangrene): A Case Report.
At a rural district hospital in Burundi, a 3-year-old severely malnourished girl with Noma presented to the operating room for placement of a gastrostomy tube. The child had a large left-sided facial defect as well as trismus. ⋯ Given that the hospital has no fiberoptic bronchoscope, direct laryngoscopy and intubation were performed directly through her facial defect. After securing the airway, the surgery proceeded without difficulty.
-
The pericapsular nerve group (PENG) block targets articular branches of the obturator, accessory obturator, and femoral nerves. This block has mostly been used to reduce pain caused by hip fractures. A catheter inserted in the plane between the iliopsoas muscle and iliopubic eminence can extend the analgesic duration. We describe the use of this block for successful pain relief of 10 patients with hip fracture (intertrochanteric, subtrochanteric, neck of femur) scheduled for surgery and continuing analgesia in the postoperative period with a catheter inserted in the musculofascial plane as described above.
-
Case Reports
Anesthetic Management of Reversible Cerebral Vasoconstriction Syndrome During Vaginal Delivery: A Case Report.
Reversible cerebral vasoconstriction syndrome (RCVS) is a rare group of vascular disorders characterized by severe headache with or without other neurologic symptoms. Pregnancy is known to precipitate RCVS, typically in the postpartum period. ⋯ Labor and vaginal delivery are characterized by fluctuations in hemodynamic and intracerebral pressures and present challenges for intrapartum anesthetic management. We report our experience with a patient with RCVS admitted for external cephalic version and subsequent vaginal delivery.
-
Case Reports
Transitioning From Intrathecal Hydromorphone to Sublingual Buprenorphine-Naloxone Through Microdosing: A Case Report.
A 76-year-old woman with chronic noncancer pain and an intrathecal hydromorphone-bupivacaine pump was admitted for acute exacerbation of heart failure. Her pump was unable to be replaced due to medical comorbidities. She was unable to tolerate oral opioids due to ventilatory depression. ⋯ Microdosing of sublingual buprenorphine-naloxone was initiated while decreasing intrathecal hydromorphone. This successfully weaned the patient off intrathecal hydromorphone with adequate pain relief and prevented both opioid withdrawal and ventilatory depression. To our knowledge, microdosing buprenorphine-naloxone to assist with discontinuing intrathecal opioids has not been previously reported in the literature.