A & A case reports
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Brachial plexus avulsion is a rare and debilitating condition frequently associated with severe, intractable neuropathic pain. Interventional treatment modalities include dorsal root entry zone lesioning, stellate ganglion blockade, and neuromodulation such as spinal cord stimulation. ⋯ After a successful trial of cervical spinal cord stimulator lead placement, she went on to an uneventful permanent implantation procedure. Spinal cord stimulation is an effective treatment for deafferentation pain and complex regional pain syndrome type II secondary to brachial plexopathy refractory to pharmacotherapy and conventional interventional attempts to modulate pain.
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Involuntary movements in patients with cerebral palsy can interfere with invasive procedures performed under sedation. We present a case of a 58-year-old man with cerebral palsy, who successfully underwent a cardiac catheterization while sedated with IV dexmedetomidine. The patient's involuntary movements were suppressed, which allowed the cardiologist to perform the procedure on an immobile, cooperative patient, all while maintaining patient comfort, stable hemodynamics, as well as adequate oxygenation and ventilation. This novel use of dexmedetomidine might facilitate monitored anesthesia care in patients otherwise requiring general anesthesia.
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Cerebral aneurysm clipping may require periods of hypotension to facilitate dissection and clip application. We describe the use of rapid ventricular pacing to facilitate establishment of controlled hypotension for an 18-month-old child during clipping for giant basilar artery aneurysm. This technique is an alternative to pharmacologic means of inducing hypotension for neurosurgical procedures and has not been previously described in children.