Journal of clinical anesthesia
-
To determine the prevalence and anesthetic impact of obesity in patients undergoing assisted reproductive technologies. ⋯ Patients with high BMI have a greater prevalence of comorbid conditions, require alterations in anesthetic and oocyte retrieval management, and more often experience intraoperative and postoperative events.
-
Intracranial subdural hematoma is a serious complication of spinal anesthesia. We report the case of a 31-year-old woman who presented with headache and neurologic localizing signs after spinal anesthesia for cesarean delivery. She was subsequently diagnosed with a right temporoparietal subdural hematoma. The hematoma was evacuated, and she had good recovery.
-
We report two patients with a history of dural puncture who developed paradoxical postural cerebrospinal fluid leak-induced headache. The patients' headache worsened when they were in the recumbent position, and it improved when they were placed upright. ⋯ The patients were successfully treated with autologous epidural blood patch. The mechanism for PPCLH is to be elucidated.
-
Case Reports
Thoracic paravertebral block for implantable cardioverter-defibrillator and laser lead extraction.
Implantable cardioverter defibrillators (ICDs) are routinely placed in the cardiac electrophysiology laboratory. Previously, these procedures were performed in the operating room during general anesthesia. ⋯ We report a case in which thoracic paravertebral blocks with mild sedation were successful for infected ICD and laser lead extraction. Randomized, controlled trials are required to determine whether thoracic paravertebral block with sedation is more effective than local anesthesia with sedation in providing adequate anesthesia for ICD placement and extraction.
-
There is a high rate of relapse among anesthesia residents attempting to re-enter clinical anesthesia training programs after completing treatment for opioid addiction. Individuals may return to clinical practice after a short period of treatment only to relapse into active addiction, and for the opioid addicted anesthesia resident, this often results in death. The objective of this study was to determine weather or not a period of time away from clinical practice after treatment would reduce the rate of relapse by allowing the individual to concentrate on recovery in the critical first year after treatment, during which the majority of relapses occur. ⋯ The treatment of addicted physicians can be successful, and return of the highly motivated individual to the clinical practice of Anesthesiology is a realistic goal, but this reintroduction must be undertaken in a careful, stepwise fashion. A full understanding of the disease process, the potential for relapse, and the implications of too rapid a return to practice must be taken into careful consideration.