A&A practice
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Atlantoaxial dislocation (AAD) poses a significant challenge in terms of positioning and surgical fixation as there is increased risk of cord compression and ischemia. Intraoperative neuromonitoring (IONM) provides a useful tool to identify impending position-related dysfunction. Here we demonstrate the utility of using transcranial motor evoked potential (Tc-MEP) to identify and treat suboptimal positioning in a 13-year-old patient with AAD and Arnold-Chiari malformation.
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After institutional ethics committee approval and informed consent, 20 patients with clavicle fractures were recruited. An ultrasound-guided C5 root block was performed by injecting 3 mL of 0.5% bupivacaine with a subsequent ultrasound-guided supraclavicular nerve (SCN) block with 3 mL of 0.5% bupivacaine. ⋯ This technique can avoid a general anesthesia for fractures of the mid and lateral clavicle. Further studies should focus on the optimal volume of local anesthetics required for the success of this technique.
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Case Reports
Extensive Lumbar Sympathetic Ganglion Block Combined With Epidural Block for Primary Erythromelalgia: A Case Report.
A 19-year-old-woman experienced severe burning pain in the lower extremities with erythema and swelling. She was diagnosed with primary erythromelalgia (PE). The pain was unresponsive to medications but relieved by immersing her feet in cold water. ⋯ An epidural block was intermittently combined. The pain and skin lesions dramatically improved after the procedures, and she no longer needed medications or to soak her feet in cold water. This case demonstrated that extensive LSGB may be a therapeutic option for intractable PE.
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Case Reports
Emergency Control of Large Aneurysmal Bleed During Endoscopic Sinus Surgery: A Case Report.
Functional endoscopic sinus surgery (FESS) is a commonly performed procedure for the treatment of chronic rhinosinusitis. It is most commonly performed as an outpatient procedure. Complications occur, including injury to the orbits, brain, and bleeding. ⋯ Controlling this bleed is difficult and could be fatal. We report a case of intraoperative bleed of an internal carotid artery aneurysm during endoscopic sinus surgery. This case demonstrates that multidisciplinary coordination and prompt management can lead to a favorable outcome.
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Anesthesiology residents spend most of their training in operating rooms, but intraoperative teaching is often unstructured. Needs assessment indicated a need to incorporate a more evidence-based approach to education and improvement of our methods of introducing residents to primary anesthesiology literature. Kern's 6-step approach to curriculum development was used to create a robust and innovative curriculum to increase both the evidence-based component of our curriculum and the amount of educational intraoperative discussion among trainees and faculty. Our curriculum uses a structured topic outline, an e-journal club, and other relevant resources to facilitate discussion of the topics.