A&A practice
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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.
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Case Reports
Continuous Intravenous Lidocaine Provides Effective Pain Control in a Palliative Child: A Case Report.
Lidocaine infusion is often used as part of a perioperative, multimodal pain management plan. We present its use to treat an 8-year-old child with devastating headaches. His symptoms stemmed from an inoperable supratentorial ependymoma that was causing thalamic bleeding and increased intracranial pressure. ⋯ These effects prevent lucidity for interactions, confound neurologic examination. A lidocaine infusion resulted in significant pain relief without these negative side effects. We discuss lidocaine infusion use and considerations for children suffering from intractable headaches.
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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.
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Patients with Pierre Robin sequence present with numerous anatomical abnormalities that make mask ventilation and tracheal intubation challenging. In this case series, we describe a unique way to overcome upper airway obstruction with the placement of a supraglottic airway in 4 children with Pierre Robin sequence followed by flexible bronchoscopic nasotracheal intubation. This new approach is proven to be a successful method to overcome severe upper airway obstruction, provide continuous oxygenation, and allows nasotracheal intubation for intraoral procedures.