A & A case reports
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Ultrasound-guided regional anesthesia requires the anesthesia provider to interpret new information. This article reports on the case of a 38-year-old man scheduled for a fifth metacarpal fracture repair. ⋯ Regional anesthesia was abandoned in favor of general anesthesia. Ultrasonography training needs to be expanded in the coming years to include awareness of the abnormal pathology, as it might impact the choice of anesthetic procedure and patient outcome.
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Case Reports
Cervical Retrograde Spinal Cord Stimulation Lead Placement to Treat Failed Back Surgery Syndrome: A Case Report.
Spinal cord stimulation is an effective treatment modality for refractory neuropathic pain conditions, but the placement of leads can be challenging due to unforeseen anatomical variations. We used a retrograde C7-T1 approach to place a lead at the bottom of T8 in a patient suffering from failed back surgery syndrome. We were able to achieve adequate stimulation in her lower back and legs, which resulted in significant reduction in pain intensity during the spinal cord stimulation trial. Cervical retrograde placement of leads may represent an alternative method for successful placement of percutaneous leads in patients with abnormal anatomy due to thoracic postsurgical changes.
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Persistent left superior vena cava is a rare vascular anatomical variant. Although ultrasonography has facilitated the process of central venous catheterization, it cannot be used to locate the tip of a catheter. ⋯ This prompted insertion of a central venous catheter on the left side of the neck in the presence of normal vascular anatomy. A subsequent chest X-ray revealed an abnormal course of the catheter consistent with presence of persistent left superior vena cava.
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Hemorrhage is a leading cause of maternal morbidity and mortality worldwide. It is especially difficult to treat in patients of the Jehovah's Witness faith because they refuse certain blood products. ⋯ Her hemoglobin nadir was 1.5 mg/dL. The case demonstrates the key place of preprocedure planning, blood conservation, and coagulation factor management in this specific patient population.
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A 24-year-old woman with history of asthma was intubated emergently for acute status asthmaticus triggered by acute respiratory syncytial virus infection and treated with permissive hypercapnia. Her ventilation was complicated by auto-positive end-expiratory pressure and elevated peak airway, plateau, and central venous pressures. On hospital day 2, she was noted to have anisocoria. ⋯ Difficult ventilation and hypercapnia directly contributed to her severe cerebral edema. Comanagement between neurologic and medical/pulmonary intensivists enabled the management of the competing treatment requirements for status asthmaticus and cerebral edema. This case highlights the importance of balancing conflicting physiologic needs and collaboration between teams.