A&A practice
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A 79-year-old woman with primary erythromelalgia underwent a left reverse total shoulder arthroplasty with a left interscalene nerve block, a superficial cervical plexus block, and a general endotracheal anesthetic, with no residual neurological deficits. Herein, we discuss the classification and pathophysiology of erythromelalgia along with the anesthetic considerations of peripheral nerve blockade in patients with primary erythromelalgia.
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Case Reports
Anesthetic Implications of a Patient With Kniest Dysplasia and Mitochondrial Disease: A Case Report.
Kniest dysplasia, or metatropic dysplasia type II, is a rare chondrodysplasia caused by abnormal type II collagen. Clinically, it is characterized by dwarfism, deafness, skeletal derangements, and ocular abnormalities. ⋯ We present the case of a 6-year-old boy with both Kniest dysplasia and underlying mitochondrial disease for examination under anesthesia before cataract surgery. Successful anesthetic management of a patient with Kniest dysplasia and a mitochondrial myopathy is discussed.
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We present the case of a primigravid patient, who developed cardiogenic shock during the early postpartum period in the setting of retained placenta, uterine atony, and hemorrhage. Focused cardiac ultrasound played a central role in identifying the cause of hemodynamic instability. The decision to initiate venoarterial extracorporeal membrane oxygenation was instrumental in the successful outcome for our patient, characterized by a full recovery without major neurological and cardiovascular sequelae.
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Case Reports
Novel Single-Needle Approach for Retrocrural Celiac Plexus Blockade Using Fluoroscopic Guidance: A Case Report.
Celiac plexus neurolysis has been shown to be an effective analgesic option for patients with visceral pain related to intraabdominal malignancies. In the setting of significant tumor burden, the celiac plexus may be inaccessible, limiting the efficacy of the transcrural approach. This case report describes a novel single-needle approach to retrocrural celiac plexus blockade, allowing for rapid blockade with a needle trajectory contralateral to the aorta in a 73-year-old woman with altered anatomy secondary to advanced metastatic colorectal cancer.
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Case Reports
Relocation of an Infected Cardiac Pacemaker Generator Under Ultrasound-Guided Pectoralis Nerve Block: A Case Study.
Reports on pacemaker placement/relocation surgery under pectoralis nerve block are limited. We herein report a case involving a 74-year-old woman with an infected cardiac pacemaker generator who underwent pacemaker relocation surgery under an ultrasound-guided pectoralis nerve block. On preoperative evaluation, she had congestive heart failure, type 2 diabetes mellitus, and a pacer-dependent heart rhythm. ⋯ Thus, an ultrasound-guided pectoralis nerve block was planned. The surgery was completed successfully, without notable complications. Our findings might help in the management of patients who require pacemaker implantation/relocation.