A&A practice
-
Transnasal humidified rapid-insufflation ventilatory exchange (THRIVE) maintains oxygenation and blunts the partial pressure of carbon dioxide (PaCO2) rise in nonpregnant subjects during apnea. Physiologic changes of pregnancy may attenuate the utility of THRIVE. ⋯ However, PaCO2 rise more closely mirrors classic apneic oxygenation in nonobstetric patients. The PaCO2 elevation and subsequent acidosis may limit the utility of THRIVE for prolonged apnea in pregnant surgical patients.
-
Case Reports
Paravertebral Block for a Patient With Achalasia Undergoing a Peroral Endoscopic Myotomy Procedure: A Case Report.
In 2016, the American Medical Association officially dismissed pain as a vital sign quoting the opioid epidemic as a major reason. Clinically, pain remains very relevant and we present the case of a patient with achalasia treated via peroral endoscopic myotomy procedure (POEM). Given that similar patients previously failed traditional pain management modalities, regional anesthesia was used in this patient's pain management. The positive outcomes yielded from this technique convinced our gastroenterological colleagues to request regional anesthesia for future patients, altering their approach to pain management.
-
Case Reports
Self-Limited Spinal Subarachnoid Hemorrhage After Lumbar Spinal Drain Removal While on Clopidogrel: A Case Report.
Spinal subarachnoid hemorrhage (SSH) is a rare yet potentially devastating complication of neuraxial procedures. We present a case of SSH after inadvertent lumbar spinal drain removal while on clopidogrel. The contrast between the patient's mild clinical symptoms compared to his impressive magnetic resonance imaging (MRI) highlights the variable presentations that can be seen with spinal and epidural hematomas. Despite sophisticated electronic warnings systems available to improve patient safety, better efforts are needed to improve interprofessional communication with providers taking care of patients with indwelling neuraxial catheters.
-
Transverse myelitis (TM) is a rare neurologic disorder of acute inflammation resulting in spinal cord injury. Chronic pain in TM is a significant detriment to quality of life. ⋯ He reported 70% improvement during the trial and was subsequently implanted with an SCS. He continues to experience significant pain relief and functional improvement (>80%) with conventional paresthesia programming at the 9-month follow-up.
-
Case Reports
Unilateral Lung Recruitment Maneuver for Massive Atelectasis in a Child With Glenn Circulation: A Case Report.
A 9-year-old girl with Glenn circulation suffered from massive atelectasis of the left lung caused by bleeding during cardiac catheterization. The atelectasis resulted in frequent hypoxia leading to oxygen saturation (SpO2) of 40%-50%. ⋯ Eventually, SpO2 improved to 80%-85%. ULRM can be a treatment option for unilateral atelectasis in a child with Glenn circulation.