A&A practice
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Motor-evoked potential (MEP) monitoring is an electrophysiologic technique useful for testing peripheral motor nerve integrity during cryoablation cases with risk of nerve injury. Previously, neuromonitoring within the magnetic resonance imaging (MRI) suite for cryoablation has not been performed as magnetic needles are used which could cause magnetic field interactions with neuromonitoring leads. We present the first report of a patient who underwent MEP monitoring during MRI-guided cryoablation of a vascular malformation adjacent to the brachial plexus. We demonstrate that MEPs may be safely and accurately performed by interleaving MRI and MEPs during treatment, reducing the risk of postprocedural complications.
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We evaluated whether a hospital-based anesthesia department can validly use automated intensive care unit (ICU) admission data after elective ambulatory procedures to assess the quality of anesthetic care. Among 13,656 patients, 25 (0.2%) had an unplanned hospital length of stay >1 night and ICU admission. ⋯ The false-positive incidence of anesthetic complications was ≥96% for scheduled ambulatory cases with ICU admission. Therefore, fully automated computerized identification of all unexpected ICU admissions after ambulatory procedures without manual review is an unsuitable (invalid) metric of individual anesthesiologists' clinical performance.
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Case Reports
Airway Management May Not Improve in Adult Patients With Pierre Robin Sequence: A Case Report.
Infants with Pierre Robin sequence present with difficult airways due to their triad of micrognathia, glossoptosis, and cleft palate. This creates a difficult airway to intubate and ventilate. ⋯ Surgeries, such as coronoidectomy, have been found to ease the difficulty of intubation in pediatric patients, but the results are not always permanent. We present an adult with Pierre Robin sequence who continued to have a difficult airway, suggesting that airway management does not necessarily improve with age.