A&A practice
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Chronic abdominal pain in the pediatric population has the potential to interfere with all aspects of life and daily functioning. Pain may originate from various sites including the viscera, fascial layers, muscles, or peripheral nerves. ⋯ We report a case highlighting the use of pulsed radiofrequency in the treatment of lower abdominal pain secondary to ilioinguinal and iliohypogastric neuralgia. In carefully selected patients, as part of a multimodal regimen, pulsed radiofrequency can aid recovery by providing effective and long-lasting pain relief, thus allowing time for effective rehabilitation.
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Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy is associated with significant volume shifts and requires meticulous hemodynamic management. The conventional and arbitrary "liberal" and "restrictive" fluid regimens are now being challenged. ⋯ Herein, we describe a case in which point of care ultrasound of the carotid artery and derived parameters were used to guide intraoperative fluid management. We discuss the reliability of this technique and the potential advantages it could offer.
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Case Reports
Nebulized Nitroglycerin for Coronavirus Disease 2019-Associated Acute Respiratory Distress Syndrome: A Case Report.
We present a case where nitroglycerin tablets dissolved in saline and intravenous nitroglycerin solution were nebulized as surrogates for inhaled nitric oxide (iNO) after our iNO supply was depleted during the coronavirus disease 2019 (COVID-19) surge in New York. We gave this treatment to a COVID-19 patient with severe acute respiratory distress syndrome (ARDS) and hypercarbia. In response, the patient had immediate and clinically meaningful improvement in multiple organ systems despite no other interventions or ventilator changes.
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Burnout is a serious problem that anesthesiologists face during training and in practice. To mitigate it, experts advocate for strategies focused on enhancing individual resilience in addition to organizational change in health care systems. To catalyze this change, wellness-focused education must incorporate foundational knowledge about the science of well-being and impart skills to empower trainees to lead change in the future. We developed and implemented a longitudinal, developmental 3-year curriculum in a large anesthesiology residency program that included strategies to strengthen community-building, enhance meaning from a career in medicine, and incorporated topics focused on career and leadership development.