A&A practice
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Case Reports
Prolonged Treatment of Inappropriate Sinus Tachycardia with Continuous Stellate Ganglion Blockade: A Case Report.
Inappropriate sinus tachycardia (IST) presents challenges in diagnosis and treatment due to its unclear etiology and limited therapeutic options. This case report explores the use of continuous stellate ganglion block (CSGB) as a potential treatment avenue. ⋯ Despite the eventual recurrence of symptoms, the sustained effects of CSGB suggest its efficacy in managing IST. This report underscores the potential of CSGB as a promising therapeutic approach for IST, offering longer-lasting symptom control compared to single-injection stellate ganglion block (SGB) interventions.
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Case Reports
Electroencephalogram-Guided General Anesthesia in a Pediatric Patient With Alexander's Disease: A Case Report.
In this case, the electroencephalogram (EEG) was used to guide anesthesia care for a pediatric patient with Alexander's Disease undergoing serial intrathecal injections. Previous procedures using a standard maintenance propofol dose of up to 225 µg/kg/min led to postanesthetic recovery times of over 6 hours, requiring a neurology consult for noncoherence. The EEG assisted in guiding maintenance propofol dosing to 75 µg/kg/min, decreasing postanesthetic wash-off and postanesthesia care unit (PACU) recovery time by 50%. This highlights the potential impact of astrocyte dysfunction on anesthetic sensitivity and robustness of EEG as a biomarker of anesthetic effect, including for pediatric patients with rare neurodevelopmental diseases.
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The Accreditation Council for Graduate Medical Education defines "nonphysician obligations" as "duties performed by nursing and allied health professionals, transport services, or clerical staff." How anesthesiology trainees understand the concept of "nonphysician obligations" and are impacted by these obligations is incompletely understood. The objective of the study was to identify how anesthesiology trainees define "nonphysician obligations," which obligations impact trainee education, and what attitudes trainees hold. ⋯ "Nonphysician obligations" are defined by a new, nuanced, specialty-specific explanatory framework, and those that impact education are summarized in distinct classes. Trainee definitions and attitudes expose possible faults in how nonphysician obligations are currently evaluated.
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EEG-based DoA monitoring is a powerful tool for ensuring the optimal balance between maintaining unconsciousness and preventing excessive sedation during procedures. Understanding the role, indications, equipment, and troubleshooting of EEG-based DoA monitoring is necessary for the effective use of this tool in clinical decision-making.