A&A practice
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Opioid-tolerant individuals have greater risk of perioperative complications and worse clinical outcomes. A preoperative screening process and structured approach to opioid-tolerant patients was developed to identify and optimize these patients before elective surgery.
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Case Reports
Transforaminal Sacral Nerve Neurostimulation for the Treatment of Intractable Chronic Pelvic Pain: Case Report.
This article aims to report the successful treatment of 2 patients with intractable chronic pelvic pain treated with transforaminal sacral nerve neurostimulation. At 18-month follow-up, both patients reported significant pain relief and improved performance. ⋯ In both reported cases, it proved to be useful for pain management. This technique should be evaluated in clinical trials.
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Methemoglobinemia is a rare disorder of the blood in which there is an increase in methemoglobin, which occurs when hemoglobin is present in the oxidized form. Methemoglobin impairs hemoglobin's ability to transport oxygen, produces functional anemia, and leads to tissue hypoxia. ⋯ The cause of methemoglobinemia in this patient remains unknown. Hypoxia and methemoglobinemia did not respond to methylene blue and required administration of packed red blood cell transfusions.
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Cranial nerve (CN) VII palsy is a rare complication of neuraxial blockade. The likely etiology of the palsy is intracranial hypotension from cerebrospinal fluid loss leading to traction on CN VII. ⋯ We present a patient who had a dural puncture with development of a headache and CN VII palsy, which improved with epidural blood patch (EBP). EBP should be considered for patients with suspected CN palsy from intracranial hypotension.
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Vasodilatory shock is common following cardiac surgery, caused by an inflammatory response to cardiopulmonary bypass (CPB). Some cases are refractory to volume resuscitation, high-dose catecholamines, arginine vasopressin, and established adjunctive therapies. Angiotensin II (ANG-2), an endogenous hormone in the renin-angiotensin-aldosterone system (RAAS), has several direct and indirect vasoconstrictive properties that make it a promising potential treatment. This case describes the successful use of ANG-2 in an anephric patient who suffered from severe refractory shock following CPB, offering a unique potential mechanism of benefit in a broader population of patients with baseline impaired RAAS.