A&A practice
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Case Reports
Perioperative Extracorporeal Cardiopulmonary Resuscitation: The Defibrillator of the 21st Century?: A Case Report.
Veno-arterial-extracorporeal membrane oxygenation (ECMO) for cardiopulmonary resuscitation (ECMO-CPR) has been recommended by new resuscitation guidelines in the United Kingdom. Our recently established yet unfunded ECMO-CPR service has thus far treated 6 patients, with 3 making a good recovery. ⋯ We argue for a pragmatic approach to funding of ECMO-CPR because observational evidence suggests superiority over traditional resuscitation and there exists major methodological and ethical barriers to randomized controlled studies. We also call for high-quality observational evidence in the perioperative setting.
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Case Reports
Sphenopalatine Ganglion Block to Treat Shoulder Tip Pain After Thoracic Surgery: Report of 2 Cases.
Shoulder tip pain may occur after thoracic surgical procedures. The pain is caused by diaphragmatic irritation and is referred to the shoulder. Shoulder tip pain is often resistant to treatment with conventional analgesics. ⋯ We report here the first use of this block to treat shoulder tip pain in 2 thoracic surgical patients. In both patients, the block produced rapid and sustained relief of the shoulder tip pain. We suggest that sphenopalatine ganglion block be considered to treat postoperative shoulder tip pain after thoracic surgical procedures.
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Ultrasound-guided femoral venous cannulation is frequently performed in neonates. Identification of femoral vessels under ultrasound navigation is unreliable and time consuming in hemodynamically unstable neonates with feeble femoral arterial pulse. ⋯ We describe 2 incidents wherein guidewires placed via femoral veins in neonates were detected in the inferior vena cava on abdominal ultrasound. We advocate abdominal inferior vena cava imaging to confirm the correct placement of a guidewire placed via femoral vein in emergency situations.
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Case Reports
Traumatic Tracheobronchial Laceration Causing Complete Tracheal Resection: Challenges of Anesthetic Management.
We report the case of a 9-year-old girl who sustained blunt trauma to the chest and presented for emergent repair of a complete tracheobronchial laceration. Tracheobronchial laceration is potentially life threatening. While conservative management has been described for simple tears, more complex injuries require surgical repair. We discuss the anesthetic challenges, airway management, and ventilation options for surgical repair in a child with a complex laceration involving the tracheobronchial tree.
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A 37-year-old gravida 5 para 4 with gestational hypertension underwent uneventful repeat cesarean delivery and tubal ligation under combined spinal-epidural anesthesia. On postoperative day 3, she developed a postural headache, unrelieved by caffeine, ibuprofen, and hydration. ⋯ An epidural blood patch was administered, providing immediate and complete relief of her headache and bilateral upper and lower dental pain, which she noted arising concomitantly with her headache. We suspect bilateral traction on cranial nerve V2 and V3, secondary to intracranial hypotension after dural puncture, as the cause of her pain.