Journal of clinical anesthesia
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Inclusion body myositis is a painless inflammatory myopathy affecting older adults. It manifests as progressive muscle atrophy and weakness, typically affecting proximal lower extremity muscles initially but insidiously progressing to affect other muscles, including bulbar (oropharyngeal) muscles and the diaphragm, and leading to dysphagia and respiratory insufficiency. This study reviews the perioperative outcomes of patients with inclusion body myositis who received general anesthesia. ⋯ Our patients with inclusion body myositis had uneventful perioperative outcomes following general anesthesia with depolarizing and nondepolarizing muscle relaxants. The small patient cohort in our series precludes a definitive conclusion regarding the safety of anesthetic agents in this patient population.
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Case Reports
Dexmedetomidine suppresses intractable hiccup during anesthesia for cochlear implantation.
We report on the successful use of dexmedetomidine to treat persistent intractable hiccup in a child who underwent cochlear implantation under sevoflurane-fentanyl anesthesia.
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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.