Articles: operative.
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To perform a narrative review of the current trials examining the use of perioperative ultrasound to diagnose common issues related to the heart, lungs, stomach, and airway. ⋯ Perioperative point-of-care ultrasound is a useful method for the diagnosis of many important perioperative conditions. The impact of this diagnostic approach on patient outcomes however remains to be determined.
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Lung ultrasound (LUS) has emerged as an effective and accurate goal-directed diagnostic tool that can be applied in real time for the bedside assessment of patients with respiratory symptoms and signs. Lung ultrasound has definite and easily recognized findings and has been shown to outperform physical examination and chest radiography for the diagnosis and monitoring of many pulmonary and pleural conditions. In this article, we review the principles of LUS image acquisition and interpretation, summarizing key terms and sonographic findings. ⋯ Because of the unique physical properties of the lungs, only a careful and systematic analysis of both artifacts and anatomical images allows accurate interpretation of sonographic findings. Future studies exploring the use of software for automatic interpretation, quantitative methods for the assessment of interstitial syndrome, and continuous monitoring devices may further simplify and expand the use of this technique at the bedside in acute medicine and the perioperative setting.
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Pain control after open abdominal surgery often includes multimodal analgesia with thoracic epidural or transversus abdominis plane (TAP) block. After liposomal bupivacaine was approved for TAP blocks in 2015, it became an alternative to indwelling catheters. However, the pharmacokinetics and safety of its use during the perioperative period have not been thoroughly investigated, especially in conjunction with parenteral opioids. We present a case report of an elderly patient having urgent laparoscopic converted to open abdominal surgery, who experienced postoperative respiratory depression in the recovery room after multimodal therapy with liposomal bupivacaine TAP blocks, intravenous (IV) opioids, and ketorolac.
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An 18-month-old patient with hereditary sensory and autonomic neuropathy, type VII undergoing general anesthesia for Nissen fundoplication and gastrostomy tube is presented. This is the first reported case of a patient with this particular genetic mutation receiving general anesthesia. ⋯ The anesthetic considerations and implications of caring for a patient with this particular mutation and patients with other variations of hereditary sensory and autonomic neuropathy are also discussed. We show that a patient with de novo hereditary sensory and autonomic neuropathy, type VII without anhidrosis did not require intraoperative narcotics and did not experience bradycardia, asystole, or hemodynamic compromise.
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The treatment of displaced midshaft clavicle fractures in children remains controversial. The purpose of our study was to compare the outcome of displaced midshaft clavicle fractures in children who were managed operatively by flexible intramedullary nailing (FIN) with nonoperative treatment. ⋯ Therapeutic, II.