A&A practice
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The PECS II nerve block is a relatively new regional anesthetic technique that targets the medial and lateral pectoral nerves, as well as the lateral cutaneous branches of the intercostal nerves. It has been described for surgical cases involving the breast, as an adjunct or alternative to neuraxial or paravertebral techniques. This case report describes the first successful use of the PECS II nerve block placed using ultrasound guidance as the primary anesthetic and postoperative analgesic in a non-breast-related chest wall surgery.
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Intranasal dexmedetomidine administered as premedication before anesthesia and cardioversion appears to have the potential to facilitate the return of sinus rhythm. Two children, 3.5 and 1.5 years old, with recurrent supraventricular tachycardia in need of cardioversion have now on several occasions spontaneously returned to sinus rhythm within 20-40 minutes after intranasal administration of dexmedetomidine (4 μg/kg) with a mucosal atomization device. Both children were observed on all occasions at the pediatric outpatient clinic and could return home within 2 hours of cardioversion. For children with supraventricular tachycardia, a selective α2-agonist might be a valuable alternative to cardioversion with adenosine.
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Horseshoe lung is an extremely rare congenital malformation in which the right and left lungs are fused due to stenosis of the lung parenchyma. In anesthetic management, it is important to avoid hypoxemia and hypercapnia caused by a decline in lung capacity and functional residual capacity. A 3-year-old boy with horseshoe lung and left lung hypoplasia was scheduled to undergo cheiloplasty. Regarding respiratory management, to prevent hypoxemia and hypercapnia, we avoided intraoperative peripheral airway obstruction with positive end-expiratory pressure, set a long inspiratory phase time for sufficient alveolar expansion, and maintained sufficient gas exchange in lungs with low reserve capacity.
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Case Reports
Anesthetic Care of 2 Siblings With Neonatal Ichthyosis and Sclerosing Cholangitis Syndrome: Case Reports.
We report for the first time the anesthetic management of 2 sisters suffering from neonatal ichthyosis and sclerosing cholangitis syndrome. They both presented with neonatal cholestatic jaundice and ichthyosis. The first was admitted for orthotopic liver transplantation at the age of 1 year, and the second patient underwent open pyeloplasty for a pyeloureteric junction syndrome at the age of 4 years. These 2 case reports highlight that, except for the potential difficulties with securing the catheters, dressings and endotracheal tube to the skin, the anesthetic implications of neonatal ichthyosis and sclerosing cholangitis syndrome are mainly related to the liver disease: cirrhosis and portal hypertension.