AANA journal
-
Fractures of the proximal upper extremity present a challenge to the anesthesia provider when administering a regional anesthetic because the dermatomal distribution of the upper extremity requires more local anesthetic coverage than any single brachial plexus nerve block can provide. A 60-year-old woman underwent intramedullary nailing of a pathologic humeral fracture using a combination of regional and general anesthesia. This case study shows how ultrasound guidance permitted the performance of both an interscalene and supraclavicular nerve block for a single procedure without the increased volume of local anesthetic that would normally be required, while still providing complete coverage of the entire upper extremity.
-
Since the Food and Drug Administration approved the da Vinci Surgical System in 2000, robotic surgery is becoming increasingly popular in the operating room. Despite its popularity and proposed benefits, robotic surgeries encompass many complications that are often confounded by the patient's physiology and comorbidities. This article illustrates a case study of a patient who underwent a da Vinci ureterectomy. The case study will highlight the implications and complications that may arise with pneumoperitoneum and steep Trendelenburg positioning, and an overview of the current literature in robotic surgery will be presented.
-
Intraoperative volume administration has long been a topic of debate in the field of anesthesia. Only recently, however, has the conversation shifted to a discussion of appropriate intraoperative volume. A thorough review of the literature explores the history of today's widely accepted fluid administration equation and discusses possible explanations and consequences of iatrogenically induced hypervolemia. Current studies exploring various volume administration techniques are reviewed, as are emerging technologies available to help guide anesthesia providers with intraoperative fluid management.
-
Some providers advocate using laryngeal mask airways (LMAs) for procedures performed in the prone position to meet the demands of quicker operating room turnover time requirements, staffing reductions and the desire to expedite patient recovery in the postoperative period. We provide an update to a 2010 systemic review examining the use of LMAs in patients in the prone position. Six peer-reviewed articles described the use of LMAs in prone patients: a randomized controlled trial, 2 description studies, a case series, and 2 case reports. ⋯ There must be a plan to control the airway if problems are encountered with the LMA. These devices might be considered as a bridge device when a prone patient is accidentally extubated. Additional rigorous studies are needed before use of LMAs in this manner can be widely recommended.
-
Comparative Study
Comparison of 3 ultrasound-guided brachial plexus block approaches for cubital tunnel release surgery in 120 ambulatory patients.
We wanted to determine whether 1 of 3 brachial plexus blocks was best for one of our most common surgeries, the cubital tunnel release with or without transposition of the ulnar nerve. Brachial plexus blocks can provide excellent results for upper extremity surgery, but we noticed inexplicable block failure for cubital tunnel releases with an incision in the proximal arm. In this case series, we initially reviewed 90 patients receiving axillary, infraclavicular, or supraclavicular blocks to determine if one block performed better for a surgical procedure that proceeds up the inner aspect of the arm. ⋯ By increasing the volume, there appeared to be less need for surgeons to "touch up" blocks in the operating room. We suggest that increasing the volume of the intercostobrachial nerve block may improve success. Further studies to identify the intercostobrachial nerve by ultrasound are needed.