HSS journal : the musculoskeletal journal of Hospital for Special Surgery
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The use of real-time ultrasound guidance has revolutionized the practice of regional anesthesia. Ultrasound is rapidly becoming the technique of choice for nerve blockade due to increased success rates, faster onset, and potentially improved safety. ⋯ Such anomalous or pathological findings may alter the choice of nerve block and occasionally affect surgical management. This case series presents a variety of musculoskeletal conditions that may be encountered during ultrasound-guided regional anesthesia practice.
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Criteria to determine which patients with obstructive sleep apnea (OSA) require intensive postoperative monitoring are lacking. Our postoperative OSA patients are all intensively monitored in the PACU and can provide such data. Thus, we reviewed patient records to determine incidence and risk factors for postoperative hypoxemia in OSA patients and subsequent association with postoperative complications. ⋯ Propensity analysis confirmed significant association of hypoxemia with adverse outcomes after adjustment for pre-existing risk factors. We conclude that postoperative hypoxemia in OSA patients is associated with adverse outcomes. Risk factors for hypoxemia were identified to guide allocation of monitoring resources to high-risk patients.
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We report a case of an 83-year-old gentleman presenting with acute low back pain and radicular left lower extremity pain after golfing. A magnetic resonance imaging (MRI) of the lumbar spine revealed a low-signal-density lesion compressing the L5 nerve. A computed tomography scan was then ordered, confirming an extra-foraminal disc protrusion at the L5-S1 level, containing a focus of gas that was compressing the left L5 nerve root and communicating with the vacuum disc at L5-S1. ⋯ A follow-up MRI performed 2 months after the procedure found an approximate 25% reduction in the size of the vacuum disc herniation. Six months after the procedure, the patient remains free of radicular pain. This case report suggests that a percutaneous aspiration of gas from a vacuum disc herniation may assist in the treatment of radicular pain.