A&A practice
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Case Reports
Ultrasound as a Useful Tool in Hydrocephalus Management During Pregnancy: A Case Report.
A 38-year-old pregnant woman in her 24th week of gestation was admitted to our neurosurgical intensive care unit with a 5-cm cerebellar hemangioblastoma and acute hydrocephalus. Initial management included the placement of an external ventricular drain to prevent neurological deterioration. Five days after the initial diagnosis, the patient successfully underwent a neurosurgical intervention to remove the lesion. Transcranial ultrasound was used to determine the optimal ventricular drain level and facilitate weaning, bypassing the need for cerebral computed tomography and cerebral magnetic resonance imaging, which would have otherwise been necessary in postoperative follow-up.
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Hi-flow nasal oxygen (HFNO) has revolutionized tubeless field anesthesia for airway surgery without the complications of jet ventilation. However, its use in third trimester parturients undergoing open airway surgery has been limited to an apneic technique (Transnasal Humidified Rapid-Insufflation Ventilatory Exchange [THRIVE]) in current publications. We used SponTaneous Respiration using IntraVEnous anesthesia and Hi-flow nasal oxygen (STRIVE Hi) in the management of tracheal dilatation in a near-term parturient at 36 weeks of gestation. Transferring this established protocol for spontaneous ventilation in the obstructed airway onto near-term parturients may mitigate the risks of apnea with hypercapnia, subsequent acidosis, and potential fetal harm.
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Case Reports
Sympathetic Blockade for the Management of Refractory Ventricular Tachycardia: A Case Report.
A 64-year-old man with a history of nonischemic cardiomyopathy (NICM) presented with electrical storm (ES). Episodes of ventricular tachycardia (VT) persisted despite endocardial catheter ablations and exhaustive pharmacotherapy. We used alternating regional anesthesia techniques, left stellate ganglion block, and proximal intercostal block to reduce sympathetic input to the heart, resulting in a significant decrease in VT burden. By using alternating catheter locations, we were able to maintain continuous sympathetic blockade for 31 days and bridge the patient to a successful orthotopic heart transplant.
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"Cannot intubate, cannot oxygenate" situations in healthy children are uncommon but are often associated with poor outcomes. Clinical assessment, anticipatory planning, and the use of algorithms can lessen the likelihood of untoward outcomes, but the common final pathway of many algorithms for a difficult pediatric airway involves obtaining emergency tracheal access. The airway practitioner must have the know-how and training needed to invasively secure the airway when confronted with this rare but potentially devastating emergency. We provide practitioners with an overview of pediatric emergency front-of-the-neck access strategies and a structure for their management.
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Case Reports
Cardiac Arrest due to Failed Pacemaker Capture After Peripheral Nerve Blockade With Levobupivacaine: A Case Report.
We describe a patient with a pacemaker who developed cardiac arrest shortly after ultrasound-guided rectus sheath block for postoperative analgesia. The cause of cardiac arrest was capture failure due to an increased pacing threshold, and the patient was promptly treated by increasing the pacing amplitude. Local anesthetics used for rectus sheath block might have affected the pacing threshold and caused pacing capture failure, since local anesthetics can block cardiac sodium channels. Anesthesiologists should recognize the risk of pacemaker capture failure when a large amount of local anesthetic is given to patients with a cardiac pacemaker.