A&A practice
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Blunt chest trauma and the treatment of associated pain can lead to impaired respiratory drive and abnormal pulmonary mechanics, in turn resulting in significant respiratory system complications. These can include pneumonia, hypoxia, atelectasis, and a prolonged need for invasive mechanical ventilation. ⋯ However, this treatment modality also carries a small risk of severe neurological complications such as spinal cord trauma, spinal cord ischemia, and epidural hematoma or abscess. This case report describes one such rare neurological complication: acute quadriparesis after thoracic epidural placement.
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Dexmedetomidine is a selective α2-agonist, frequently used in perioperative medicine as anesthesia adjunct. The medication carries a Food and Drug Administration pregnancy category C designation and is therefore rarely used for parturients undergoing nonobstetric surgery. We are reporting the use of dexmedetomidine in the anesthetic management of a parturient undergoing minimally invasive unilateral adrenalectomy for pheochromocytoma during the second trimester of pregnancy. Additionally, because of the multiple endocrine neoplasia type 2A constellation with diagnosis of medullary thyroid cancer, the patient underwent a total thyroidectomy 1 week after the adrenalectomy.
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Case Reports
Confirmation of Erector Spinae Plane Block Analgesia for 3 Distinct Scenarios: A Case Report.
Analgesia for many open thoracic and abdominal procedures has traditionally been accomplished through neuraxial techniques or paravertebral blocks. Erector spinae plane (ESP) blocks purport effective analgesia over a similar anatomical distribution with a more favorable side effect profile and complication rate than epidurals. However, the extent of clinical applicability for ESP blocks has yet to be elucidated. In this case series, we demonstrate the efficacy of ESP blocks for 3 distinct etiologies of acute pain: planned perioperative analgesia, rescue postoperative analgesia, and traumatic pain.
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Case Reports
Mitral Valve Compression Induced Hypoxemia After Left Ventricular Assist Device Surgery: A Case Report.
Blood flow obstruction of left ventricular assist device (LVAD) is not uncommon. Causes of flow obstructions could be prepump, intrapump, and postpump. Clinical and echocardiographic parameters of LVAD obstruction vary substantially, ranging from being completely asymptomatic with unchanged functional status, normal filling pressures to frank cardiogenic shock. In the current case report, we present hypoxemia as an early presentation of LVAD inflow obstruction in the early postimplantation period in the absence of respiratory cause for hypoxemia.
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Case Reports
Laparoscopic Surgery in Infants Under Spinal Anesthesia Block: A Case Report of 3 Cases.
Spinal anesthesia (SA) is a valuable alternative to general anesthesia in infants, but laparoscopic surgery is considered a contraindication in this age group. We report 3 cases of SA for inguinal hernia repairs. The contralateral inguinal region was explored by laparoscopic port placement and pneumoperitoneum through the surgical site. ⋯ Opioids were spared in 2 patients. Pain scores were low throughout. SA as a primary anesthetic may be used in pediatric laparoscopic procedures.