A&A practice
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Case Reports
Use of Continuous Glucose Monitoring to Facilitate Perioperative Glycemic Management: A Case Report.
Perioperative glycemic management remains an important variable in a host of postoperative outcomes, including wound infection, reoperation, and death. Patients with diabetes mellitus are increasingly utilizing continuous glucose monitors to assist with glycemic management; the ability to harness the intensive monitoring capabilities of continuous glucose monitoring (CGM) technology perioperatively presents a promising opportunity to improve patient outcomes. Here, we assessed the accuracy of CGM compared to capillary point-of-care and arterial blood analysis in 2 cases where CGM was utilized as an adjunct method of perioperative glucose monitoring.
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The right supraclavicular fossa view allows for ultrasonographic visualization of the central veins. A preprocedural scan of an asymptomatic 38-year-old man referred for peripherally inserted central catheter (PICC) insertion revealed a large thrombus in the right brachiocephalic vein. ⋯ Using the right supraclavicular view, the PICC was visualized in the left brachiocephalic vein, and the catheter was followed to its final position, avoiding contact with the thrombus. Thus, the right supraclavicular fossa view allowed for the detection of relevant pathology and facilitated an alternative feasible strategy with real-time catheter guidance during PICC insertion.
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We present a case of a child with Aicardi-Goutières Syndrome (AGS) undergoing general anesthesia for placement of a laparoscopic gastrostomy tube. AGS is a rare genetic leukodystrophy that can affect most organ systems with extensive neurologic effects. ⋯ We describe our anesthetic management and discuss these implications. The patient had a prolonged duration of action of rocuronium and an otherwise uneventful anesthetic course.
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The sacroiliac joint (SIJ) is a common source of pain in patients with low back pain. Untreated pain from the SIJ can lead to prolonged discomfort and financial burden. ⋯ However, there is no clear description of SIJ cryoneurolysis in the published literature. In this report, we present 5 patients with SIJ-related pain and we describe the ultrasound-guided SIJ cryoneurolysis technique and its analgesic efficacy.
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We report the management of a parturient with undiagnosed hypokalemic periodic paralysis (HOKPP) who underwent epidural analgesia for labor, complicated by an unintentional dural puncture, and the eventual use of epidural anesthesia for cesarean delivery. Following discharge, she represented with lower extremity paresis. After being evaluated for a compressive neuraxial lesion, she made a full recovery following potassium repletion. The obstetric anesthetic implications for patients with HOKPP and how this disorder impacts the evaluation of acute motor weakness in the immediate postpartum period in a patient who recently received a neuraxial procedure are discussed.