Articles: postoperative.
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Pediatr Crit Care Me · Aug 2018
Observational StudyCharacterization of the Glucocorticoid Receptor in Children Undergoing Cardiac Surgery.
Postoperative administration of corticosteroids is common practice for managing catecholamine refractory low cardiac output syndrome. Since corticosteroid activity is dependent on the glucocorticoid receptor, we sought to characterize glucocorticoid receptor levels in children undergoing cardiac surgery and examined the association between glucocorticoid receptor levels and cardiovascular dysfunction. ⋯ Increasing glucocorticoid receptor levels in peripheral WBCs of children undergoing cardiac surgery are associated with a longer time to being inotrope free. Cortisol levels minimally increased during the study duration. These results suggest that exposure to high-dose perioperative corticosteroids may suppress the hypothalamic-pituitary-adrenal axis leading to increase in glucocorticoid receptor levels in response to a low cortisol environment. Further studies are required to better delineate the interplay between glucocorticoid receptor levels, cortisol levels, corticosteroid exposure, and postoperative inotropic requirements.
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Case Reports
Axillary Artery Dissection After Ultrasound-Guided Infraclavicular Brachial Plexus Block: A Case Report.
A 52-year-old man with end-stage renal disease underwent ultrasound-guided infraclavicular brachial plexus block for revision of an arteriovenous fistula. On postoperative day 2, the patient developed pain and loss of motor function in the surgical extremity. ⋯ Sensory deficits resolved over the next 3 days. Smoking, hypertension, diabetes mellitus, and chronic intake of a calcineurin inhibitor might have predisposed the patient to iatrogenic arterial dissection.
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While it has been shown that a paravertebral block provides effective postoperative analgesia for patients undergoing thoracic surgeries, including first rib resection, this is the first reported case of a paravertebral catheter used for perioperative analgesia in a patient undergoing first rib resection. We present the case of a 76-year-old woman with right upper extremity swelling who underwent infraclavicular first rib resection for venous thoracic outlet syndrome. Continuous infusion of ropivacaine through a T1 paravertebral catheter, which was placed before induction of general anesthesia but after T1 and T2 paravertebral blocks, provided effective postoperative pain control. Our experience suggests that paravertebral catheter infusions of local anesthetics may be effective adjuncts to general anesthesia in patients undergoing first rib resection and warrants further investigation.