A&A practice
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Review Case Reports
Pain Management in Brugada Syndrome: A Case Report and Review.
Brugada syndrome is a rare condition that increases the risk of life-threatening arrhythmias. Although there are existing anesthesia recommendations for patients with Brugada syndrome, guidance on pain management is limited. ⋯ She received perioperative multimodal analgesia, which included neuropathic agents (pregabalin, duloxetine), and opioids (morphine, codeine). Our findings contribute to a greater understanding of safe analgesic practices for patients with Brugada syndrome.
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Case Reports
Regional Anesthesia Management in a Fontan Patient Presenting for Ambulatory Shoulder Surgery: A Case Report.
Interscalene blocks, commonly used for shoulder surgery analgesia, often cause transient phrenic nerve palsy, leading to hemi-diaphragmatic paresis. This complication is particularly problematic in patients with pulmonary comorbidities and has been extensively investigated. ⋯ Hemi-diaphragmatic paresis can significantly reduce negative pressure spontaneous ventilation, leading to decreased venous return and increased pulmonary vascular resistance, which critically affects cardiac output. This case report explores regional anesthesia management in a Fontan patient undergoing shoulder surgery, emphasizing the suprascapular nerve block as an effective alternative for ambulatory patients.
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Case Reports
Cervicothoracic Emphysema After Nasotracheal Intubation Attempt: A Life-Threatening Complication-A Case Report.
Nasotracheal intubation is a commonly used technique in elective oral and pharyngeal surgeries. This case report details an incident involving a young adult patient in which an attempt at nasotracheal intubation resulted in a life-threatening cervicofacial and thoracic emphysema. Although complications associated with nasotracheal intubation are rare, their potential severity necessitates a comprehensive preprocedural discussion and risk assessment with the surgical team to confirm its appropriate indication for each individual patient. This case underscores the need for increased awareness and readiness for managing rare but critical complications associated with airway management techniques.
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Carbon dioxide gas emboli is a potentially fatal complication that occurs more frequently during laparoscopic hepatectomy compared to other laparoscopic surgeries. The patient featured in this report had massive gas embolism confirmed by intraoperative transesophageal echocardiography (TEE) that were associated with episodes of severe hypoxemia, hemodynamic instability, and right ventricular failure requiring conversion to open hepatectomy. Abrupt abdominal decompression resulted in massive hemorrhage from a previously undetected defect in the middle hepatic vein. The report demonstrates the successful management of gas embolism during laparoscopic hepatectomy even with a significant delay in vascular repair and highlights the critical role of TEE.
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Evaluations performed before the day of surgery at perioperative clinics have been shown to reduce patient mortality and hospital lengths of stay. These clinics are becoming increasingly adopted worldwide. As the number of older patients undergoing surgery continues to increase, understanding the perspectives of this patient population regarding the preoperative evaluation process is essential to tailor care to their needs and preferences. ⋯ Preanesthesia assessments allow for bidirectional communication between patients and anesthesia providers, alleviating patient anxiety and allowing for vital patient information to be collected to enhance overall patient safety. Our findings indicate that preoperative assessment by an anesthesia provider is desired and valued by the older patient population, contributing to the evidence in support of the implementation of anesthesia preoperative clinics. More research is needed to determine whether tailoring preanesthesia assessments to better align with patient preferences will translate into enhanced patient-centered outcomes.