A&A practice
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Case Reports
Ultrasound-Guided Selective Trunk Block to Produce Surgical Anesthesia of the Whole Upper Extremity: A Case Report.
None of the classical brachial plexus block techniques can reliably produce surgical anesthesia of the whole upper extremity that is from shoulder to hand. We describe ultrasound-guided "selective trunk block" (SeTB) that was successfully used to produce surgical anesthesia of the whole ipsilateral upper extremity in a patient undergoing intramedullary nailing of the humerus for a pathological fracture. The 3 trunks of the brachial plexus were individually identified and selectively blocked with 2 separate injections. We conclude that SeTB is a viable option when surgical anesthesia of the whole upper extremity, except for the intercostobrachial nerve (T2) territory, is being considered.
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We describe a patient with an intrathecal drug delivery system (IDDS) for management of chronic back pain who developed worsening pain symptoms associated with an infected catheter tip, identified years after initial implantation. A 72-year-old woman had an IDDS initially implanted for management of chronic back pain. ⋯ Her pain worsened, and after explantation of the IDDS, methicillin-resistant Staphylococcus aureus colonized the catheter tip. Worsening pain symptoms in a patient with intrathecal morphine pump must be met with a broad differential diagnosis.
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N95 respirator masks are used by medical providers for respiratory protection from airborne pathogens of transmissible diseases. In extreme situations or pandemics, when N95 masks may be in short supply, the American Society of Anesthesiologists (ASA) reported that some groups created their own N95 mask utilizing an anesthesia circuit mask plus a filter for use in short but high-risk procedures. The makeshift option for personal protective equipment was tested with a qualitative respirator mask fit test.
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We report a series of 20 neonates and infants (18 born preterm) who underwent laparoscopic inguinal hernia repair with caudal anesthesia, oxygen via nasal cannula, and intravenous anesthesia. Surgery was successful in all cases without airway instrumentation or intraoperative complications. Sedation was provided with dexmedetomidine, propofol, and remifentanil. ⋯ Laparoscopy allowed unplanned bilateral repair in 2 cases. Caudal with intravenous anesthesia without airway instrumentation is a viable technique for laparoscopic inguinal hernia repair. Avoiding general endotracheal anesthesia may reduce perioperative complications and influence postoperative disposition.
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Case Reports
Management of Tracheoesophageal Fistula Repair With Cardiac Dextroposition and Right Lung Agenesis: A Case Report.
Tracheoesophageal fistulae (TEF) commonly occur as part of the vertebral defects, anal atresia, cardiac defects, tracheoesophageal fistula, renal, and limb abnormalities (VACTERL) association. However, pulmonary agenesis is not typically seen with TEF. We report the anesthetic management of a TEF repair in a 33-week-old, 1.6-kg, monochorionic diamniotic twin with right lung agenesis, intrauterine growth restriction, and cardiac dextroposition. Due to the unique position of the heart, the patient periodically lost complete cardiac output during the exposure and repair of the esophagus.