A&A practice
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Case Reports
Stellate Ganglion Block for Electrical Storm Associated With Takotsubo Cardiomyopathy: A Case Report.
Takotsubo cardiomyopathy (TCM) is a reversible condition characterized by apical ballooning of the left ventricle, primarily triggered by catecholamine discharge due to stress. Patients may present with symptoms similar to acute coronary syndrome or with refractory ventricular arrhythmias such as QT prolongation, ventricular tachycardia, and ventricular fibrillation. We report a case of TCM with prolonged QT intervals and refractory ventricular arrhythmias, triggered by noncardiac systemic insult, that responded successfully to stellate ganglion block (SGB). This case highlights the potential of SGB as an effective intervention for managing refractory arrhythmias in TCM patients.
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Case Reports
Unusual Resistance to Intravenous Anesthetic Drugs in a Rachipagus Infant: A Case Report.
In conjoined twins when one of the twins is incompletely formed and is dependent on the healthy counterpart for survival, they are described as heteropagus (parasitic) twins. Rachipagus is a type of parasitic twin joined at the spine above the sacrum. ⋯ The infant was resistant to multiple anesthetic drugs like fentanyl, propofol, and ketamine. Later general anesthesia was induced with thiopentone sodium, and the procedure went on uneventfully.
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This case report highlights a unique instance of spinal myoclonus after neuraxial anesthesia. It aims to inform anesthesiology providers, enhancing their ability to identify, manage, and potentially prevent similar outcomes in patients at risk.
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Thoracic epidural analgesia is commonly used for postoperative analgesia for abdominal and thoracic surgeries. One complication of thoracic epidural catheter placement is a malpositioned catheter, such as in the subarachnoid, subdural, or intrapleural space. ⋯ The catheter produced a sensory level and analgesic benefit and was only identified incidentally on computed tomography (CT) imaging. This case highlights another possible anatomic location for unintentional catheter placement, which may be more common than reported, as it functioned as an epidural catheter by all clinical metrics and would not have been identified without imaging.
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Clavicle fractures are the most common fractures of the shoulder girdle. Due to the complex sensory innervation of the clavicle, patients' pain scores are high in the postoperative period. ⋯ It provides analgesia between C3 and T10. In this case report, our experience with SPSIPB, which we applied for rescue analgesia in a patient who underwent surgery for a clavicle fracture, is described.