A & A case reports
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Improvement of living and socioeconomic conditions, developments, and innovations in medicine and technology has prolonged of life expectancy. We provided spinal anesthesia for a 111-year-old woman requiring internal fixation of a fractured femur. ⋯ The patient was discharged from the intensive care unit after 24-hour monitoring without any complications. She was discharged from the hospital on postoperative day 2.
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The transversalis fascia plane block is a relatively new truncal block that targets the iliohypogastric and ilioinguinal nerves. It is gaining wider usage for its reliability to block these nerves as compared with the transversus abdominis plane block. The case presented here appears to be the first time that motor weakness has resulted from this block technique. It is suspected that central and proximal spread of local anesthetic toward the psoas muscle may have resulted in a partial lumbar plexus block.
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We present a case of acute postoperative abdominal pain after proctosigmoidectomy and colorectal anastomosis that was treated by bilateral continuous quadratus lumborum block. The block was performed in the lateral position under ultrasound guidance with a 15-mL bolus of 0.5% bupivacaine injected anterior to the quadratus lumborum muscle followed by bilateral catheter placement. ⋯ The block was devoid of hemodynamic side effects or motor weakness. This case demonstrates that bilateral continuous quadratus lumborum catheters can provide extended postoperative pain control.
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The ability to apply perioperative ultrasound techniques is a desirable skill for clinicians. We implemented a multimodal 13-day basic ultrasound course for 6 anesthesia interns. ⋯ They maintained their ability to acquire echocardiographic images on a simulator 90 days later with kinematic measures superior to the same seniors. Through this course, interns gained knowledge and skills equal to or greater than seniors.
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Arterial gas embolism can be caused by direct entry of gas into systemic arteries or indirectly by venous-to-arterial shunting. Although arterial gas embolism is rare, most documented cases are iatrogenic, resulting from the entry of gas during procedures that involve direct vascular cannulation or intracavitary air insufflation. Of the 18 identified case reports of air embolism during endoscopy, 11 cases describe findings of cerebral arterial gas embolism during upper endoscopy. ⋯ We report a rare case of cerebral arterial gas embolism in a 64-year-old woman, which occurred during endoscopic dilation of an esophageal stricture and was subsequently treated with hyperbaric oxygen therapy. In this case report, we explore the possible etiologies, clinical workup, and therapeutic management of cerebral artery gas embolisms. Hyperbaric oxygen therapy is the treatment of choice for cerebral arterial gas embolism, with earlier treatments resulting in better outcomes.