A&A practice
-
Case Reports
Inappropriate Defibrillator Shocks During Cervical Medial Branch Radiofrequency Ablation: A Case Report.
A 52-year-old woman with a history of cervical spondylosis, nonischemic dilated cardiomyopathy, and complete heart block with implantation of a cardiac resynchronization therapy defibrillator (Inogen XR, Boston Scientific, Natick, MA) underwent bilateral fluoroscopy-guided radiofrequency ablation of the medial branch nerves at C4, C5, and C6 levels at an ambulatory surgery center. After completion of the seemingly routine procedure, several alerts, including 1 inappropriate shock, were received via Boston Scientific's remote monitoring system. Tracings also showed that pacing inhibition occurred. When performing radiofrequency ablation in patients with a cardiac implantable electronic device, it is imperative to follow published best practice recommendations to minimize the risk of adverse events.
-
Case Reports
Continuous Intravenous Lidocaine Provides Effective Pain Control in a Palliative Child: A Case Report.
Lidocaine infusion is often used as part of a perioperative, multimodal pain management plan. We present its use to treat an 8-year-old child with devastating headaches. His symptoms stemmed from an inoperable supratentorial ependymoma that was causing thalamic bleeding and increased intracranial pressure. ⋯ These effects prevent lucidity for interactions, confound neurologic examination. A lidocaine infusion resulted in significant pain relief without these negative side effects. We discuss lidocaine infusion use and considerations for children suffering from intractable headaches.
-
Patients with Pierre Robin sequence present with numerous anatomical abnormalities that make mask ventilation and tracheal intubation challenging. In this case series, we describe a unique way to overcome upper airway obstruction with the placement of a supraglottic airway in 4 children with Pierre Robin sequence followed by flexible bronchoscopic nasotracheal intubation. This new approach is proven to be a successful method to overcome severe upper airway obstruction, provide continuous oxygenation, and allows nasotracheal intubation for intraoral procedures.