A & A case reports
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Effective communication with patients is essential to quality care. Obviously, language barriers significantly impact this and can increase the risk of poor patient outcomes. ⋯ Although quite beneficial, use of technology that is not validated exposes providers to unnecessary medicolegal risk. We hope to highlight the need for validation of such technology to ensure that these tools are an effective way to accurately communicate with patients in the perioperative setting.
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In recent years, the technique of combined ultrasound and electrical stimulation-guided nerve block has been recommended. We present 2 patients with Duchenne muscular dystrophy who exhibited different muscle responses to nerve stimulation during the performance of peripheral nerve blocks for surgeries. Whereas a 2-year-old boy without severe disability showed the expected muscle contraction to electrical nerve stimulation, a 14-year-old boy with severe disability showed no muscle response. Our experience suggests that muscle responses to electrical nerve stimulation will vary with the stage of Duchenne muscular dystrophy.
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Case Reports
Intravenous Caffeine Rescue for Postoperative Hypoventilation in a 16-Year-Old With Trisomy 10: A Case Report.
Trisomy 10 is a rare disorder, with only 35 cases reported in the literature. Anesthetic management may be challenging in this patient population because of craniofacial, cardiac, and renal abnormalities commonly seen in the disorder. We describe a 16-year-old male with an anesthetic history notable for prolonged emergence, postoperative hypoxia, postoperative reintubation, and unexpected hospital admission presenting for dental extraction of impacted teeth. We utilized intravenous caffeine, a respiratory stimulant used in preterm infants, to facilitate recovery from anesthesia.
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Osteogenesis imperfecta (OI) is a rare disabling genetic connective tissue disorder. General anesthesia in these patients is associated with increased risks. ⋯ We are reporting the use of combined spinal-epidural anesthesia for a prolonged surgery (multiple osteotomies) of lower limbs in a 10-year-old wheelchair-bound child with OI type III. Preoperative counseling, ultrasonography guidance, titrated local anesthetic dosage, and dexmedetomidine sedation helped establish optimum surgical conditions.
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Case Reports
Obstetric Anesthesia for a Pregnant Woman With Brainstem Cavernous Malformations: A Case Report.
There are no well-defined guidelines for obstetric and anesthetic management of pregnant patients with cerebral cavernous malformations (CMs). We need to pay careful attention to the attendant risks of both general and neuraxial anesthesia in this population. Here, we describe the anesthetic management of a pregnant woman with brainstem CMs who underwent cesarean delivery. We selected a general anesthetic technique because of concerns of undesirable effects of neuraxial anesthesia in the presence of cerebral CMs.