A & A case reports
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Tracheal stenosis in pregnancy is a relatively rare occurrence and there are limited data regarding the perioperative management of these patients. Various surgical treatment options are available to include open repair, long-term tracheostomy, or endoscopic repair (rigid versus balloon dilation). We report the case of a woman in her third trimester of pregnancy, with known recurrent and worsening history of subglottic tracheal stenosis, who underwent awake microlaryngoscopy with potassium titanyl phosphate laser radial incision and serial tracheal balloon dilation under topical anesthesia with sedation. We further discuss her perioperative multidisciplinary management.
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We describe using ultrasound-guided peripheral nerve blocks for postoperative pain control in 2 children undergoing ventricular shunt surgery. In the first patient undergoing ventriculo-peritoneal shunt revision, a combination of ultrasound-guided greater occipital nerve, superficial cervical plexus, and transversus abdominis plane blocks was used. ⋯ Both patients, who underwent multiple revisions during their hospitalizations, showed decreased analgesic requirements after regional anesthesia. Our experience suggests this combined block technique may provide beneficial postoperative analgesia for patients undergoing shunt revision.
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In this report, we describe a case of posterior reversible encephalopathy syndrome in a female patient after deceased donor liver transplantation. She developed posterior reversible encephalopathy syndrome on postoperative day 3 and did not improve despite adjustments in immunosuppressive therapy. ⋯ Reductions in therapeutic support were ultimately successful after 62 days of continuous pentobarbital therapy. The patient awoke neurologically intact and was discharged to a rehabilitation center in good condition.
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Patients receiving extended-release (XR) naltrexone who are having surgery present unique challenges to anesthesia providers, the most obvious of which is an altered response to the effects of opioid agonists. Based on the timing of the last XR naltrexone dose, patients may be refractory to the effects of opioid agonists or potentially more sensitive to dangerous side effects due to receptor upregulation and hypersensitivity. ⋯ We present a case of a 22-year-old woman receiving XR naltrexone for a history of heroin abuse undergoing a thyroidectomy and neck dissection. We discuss the intraoperative and postoperative anesthetic and analgesic planning, as well as solutions to some of the challenges these patients pose.