A&A practice
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The role of neuromodulation in fascial plane blocks is unknown. This case report presents a complex patient who underwent shoulder arthroplasty with a high thoracic-erector spinae plane (HT-ESP) catheter that provided electrical and chemical neuromodulation, highlighting the potential of electrical stimulation in the identification of and therapy at the fascial plane level.
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Brachial plexus avulsion injuries result in permanent motor and sensory deficits, leading to debilitating symptoms. We report the case of a 25-year-old man with chronic pain following right-sided C5-T1 nerve root avulsion without evidence of peripheral nerve injury. ⋯ These results agree with data suggesting collateral sprouting of sensory nerves occurs following a brachial plexus injury. Further study is needed if we are to understand the mechanisms of the peripheral nerve stimulator as a treatment option.
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Case Reports
Refractory Hypoxemia on VV-ECMO: Repetition of a Structured Approach Is Paramount: A Case Report.
Veno-venous extracorporeal membrane oxygenation (VV-ECMO) is increasingly used to manage severe respiratory failure. Unfortunately, refractory hypoxemia often complicates VV-ECMO support. ⋯ Frequent recalculation of cardiac output and oxygen delivery enabled early diagnosis and treatment of these conditions. We highlight the need for a structured and oft-repeated approach to this complex problem.
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A peripheral nerve block may be used to improve patient tolerance of awake intubation. During an awake intubation, the glossopharyngeal, superior laryngeal, and recurrent laryngeal nerves can mediate discomfort, pain, cough, glottic closure, and gag reflexes. ⋯ The glossopharyngeal nerve block was performed via the parapharyngeal space approach targeting the distal glossopharyngeal nerve. This procedure resulted in an uneventful awake intubation.
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Elongation-derotation flexion casting, commonly referred to as Mehta casting, is a relatively new treatment for infantile idiopathic scoliosis. Surgeons have noted remarkable, sustained improvement in scoliosis following treatment with serial Mehta plaster casts. ⋯ This case series examines 4 children who underwent Mehta casting at a single tertiary institution. Complications included endotracheal tube obstruction, hypothermia, pressure point injuries, and prolonged exposure to general anesthesia (GA) that potentially increases the risk of long-term neurodevelopmental delay.