A&A practice
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Ultrasound (US)-guided transversalis fascia plane block (TFPB) was first described by Hebbard as a technique for blockade of T12-L1 nerves. Although this technique appears similar to the quadratus lumborum 1 block, the point of injection is more caudal and anterior, specifically targeting ilioinguinal and iliohypogastric nerves. ⋯ We report the use of US-guided TFPB in a patient undergoing inguinal herniorrhaphy. Our experience suggests that this technique could represent a viable alternative to general anesthesia and standard regional techniques for inguinal hernia repair.
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A 16-year-old boy with Chiari 1 malformation presented for an elective suboccipital craniectomy and C1 laminectomy. His intraoperative course was uneventful. At the conclusion of the procedure, he met extubation criteria and followed commands. ⋯ He was reintubated via videolaryngoscopy, which showed edema not only to the tongue, but also to the posterior pharynx and blisters over the vocal folds and epiglottis. The patient was transferred to the pediatric intensive care unit intubated and sedated. This report describes the clinical course of his massive macroglossia and discusses short- and long-term management.
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Kratom is an herb indigenous to Southeast Asia with psychoactive opioid compounds, often used as a treatment for chronic pain or opiate withdrawal symptoms. It is legally and readily available via Internet sales and has been identified as an emerging drug of abuse in the United States. ⋯ At lower doses, kratom acts as a stimulant, while at higher doses, it produces analgesia and euphoria. Here, we describe the successful management of kratom overdose and withdrawal in a young man with negative toxicology screens.
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Jehovah's Witness patients have unique perioperative challenges involving blood products. We describe the use of a novel method to maintain a closed circuit between a Jehovah's Witness patient's arterial blood and the epidural space while performing a blood patch for postdural puncture headache. Previously described methods have utilized venous catheters to maintain a closed circuit between the body and the epidural space. This is the first report we are aware of that utilizes a closed-circuit arterial blood supply to create an epidural blood patch in a Jehovah's Witness patient.
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Cardiovascular disease is the leading cause of peripartum death in the United States during pregnancy. The presence of concomitant diagnoses may complicate or conflict with the management of the primary cardiovascular diagnosis and further complicate pregnancy and delivery. We describe the management of a 29-year-old, gravida 5, para 1 woman with severe peripartum cardiomyopathy during this and a previous pregnancy complicated by multiple endocrine neoplasia type and factor V Leiden thrombophilia, limiting therapeutic options and contributing to considerable perioperative management challenges.