A&A practice
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Case Reports
Use of Virtual Reality as a Surrogate for Parental Presence During Anesthetic Induction: A Case Report.
Virtual reality (VR), a computer-generated simulation of a 3-dimensional environment, is a relatively new method of providing distraction before and during procedures. We describe the use of a VR multiuser application, Oculus Rooms, to calm an anxious 10-year-old boy during transportation to the operating room and induction of anesthesia. The use of VR could lessen the perioperative anxiety of children by maintaining a virtual child-parent connection while avoiding the potential drawbacks to having parents actually in the operating room before and during induction of anesthesia. The success of this novel technique has important implications for future clinical trials and practice.
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Persistent cervicothoracic myofascial pain is a common condition that causes loss of function and can result in significant health care costs. The underlying cause is tender trigger points that result in impaired muscle function. ⋯ The authors present a novel treatment in 2 patients presenting with severe unilateral cervicothoracic myofascial neck pain that failed to respond to standard treatment. The novel treatment, ultrasound-guided intermediate cervical plexus block with depot steroids, produced significant and durable pain relief in the 2 patients.
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Intraoperative neurophysiological monitoring involves electrical stimulation of nerve pathways and is used to assess the integrity of both motor and sensory pathways. Whereas motor pathway monitoring involves transcranial stimulation and peripheral nerve monitoring, somatosensory monitoring involves peripheral nerve stimulation and cranial monitoring. ⋯ We describe a case of bradycardic arrest with somatosensory-evoked potential monitoring using median nerve electrodes in a patient with no previous rhythm abnormality. Clinicians caring for patients receiving somatosensory monitoring should be aware of the potential for severe arrhythmias.
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Here we present the case of a 76-year-old woman with pancreatic cancer receiving epidural analgesia for chronic cancer pain treatment. Attempts of running the epidural catheter sequentially resulted in unexpected and extensive sensory block together with sympathicolysis but insufficient pain control. ⋯ The MRI showed subdural catheter displacement with extensive liquid accumulation in the subdural space and consequent significant spinal cord compression. Findings normalized after removing the subdural catheter.