Journal of clinical anesthesia
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The primary goal of this study was to determine whether transversus abdominis plane (TAP) blocks were effective as the primary anesthetic technique for insertion and/or removal of peritoneal dialysis catheters. ⋯ Transversus abdominis plane blockade can be successful at serving as the primary anesthetic modality for the insertion and/or removal of a peritoneal dialysis catheter by open-surgical approach. There were no systemic toxic effects or other complications recorded.
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Comparative Study
Patient preference for the pre-anesthesia evaluation: Telephone versus in-office assessment.
Pre-anesthesia evaluation (PAE) is designed to reduce patient and family anxiety, identify pre-existing health issues, avoid surgical delays, minimize costs, and tailor an anesthetic plan. If PAE requires a clinic visit, patients must take time off work and may incur travel and childcare costs. A telephone-based Preoperative Assessment Clinic can minimize patient inconvenience, while maintaining high-quality patient care and improving efficiency. We assessed patient satisfaction with a telephone PAE and determined whether patients preferred a telephone PAE or a conventional clinic visit. ⋯ The majority of patients in this survey preferred a telephone PAE. Given the large catchment area of our hospital of nine counties, telephone-based interviews add to patient convenience and likely increase compliance with the PAE. Even patients who live in close proximity to our hospital (<5 mi) preferred a telephone assessment. A telephone-based PAE provides high patient satisfaction over a traditional office visit while increasing patient convenience. Larger studies are necessary to ensure that telephone PAEs compare well with in-person examinations.
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Case Reports
Compartment syndrome in a patient treated with perineural liposomal bupivacaine (Exparel).
Acute compartment syndrome is a condition that may result in sensorimotor deficits and loss of function of the affected limb as a result of ischemic injury. It is considered a surgical emergency and prompt diagnosis and treatment results in more favorable outcomes. The use of regional anesthesia is controversial in patients at risk for compartment syndrome due to concern of its potential to mask symptoms of the condition. ⋯ The diagnosis of compartment syndrome requires a high index of suspicion and prompt treatment. This patient's changing pattern of symptoms-rather than his pain complaints alone-resulted in the diagnosis of compartment syndrome treated with emergent fasciotomy in spite of finger numbness that was initially attributed to the liposomal bupivacaine. While the use of liposomal bupivacaine did not preclude the diagnosis of compartment syndrome in our patient, it should be used with caution in patients at risk for compartment syndrome until additional data, particularly regarding block characteristics, are available.
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A 3-year-old girl presented for routine closure of her tracheostomy site. She was intubated easily for the procedure, and the wound was closed with a drain in place. In recovery, the mother noticed fullness in the patient's submandibular region, and on examination, the girl had subcutaneous emphysema in the neck bilaterally. ⋯ The wound was again closed with a drain in place, and the patient was extubated uneventfully. After arriving to the pediatric intensive care unit for monitoring, the patient acutely developed respiratory distress and was found to have pneumomediastinum and pneumothorax and was emergently intubated. She was observed closely, and the following day, the pneumothorax improved, and she successfully extubated without further complication.
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Case Reports
Anesthetic management of an ex utero intrapartum treatment procedure: a novel balanced approach.
Ex utero intrapartum treatment (EXIT) procedures are therapeutic interventions for fetuses with life-threatening airway abnormalities and/or other prenatally diagnosed congenital malformations requiring immediate neonatal extracorporeal membrane oxygenation support. Although certain anesthetic goals are common among EXIT procedures, many different approaches to their management have been described in the literature. Herein, we present a novel anesthetic approach to an EXIT procedure for fetal micrognathia and retrognathia. We also review the indications and anesthetic considerations for these procedures and highlight the need for multidisciplinary collaboration to optimize clinical outcomes.