A&A practice
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Spinal anesthesia is administered for select procedures in the pediatric population and offers a safe alternative to general anesthesia. In this case series, we report loss of corneal and eyelash reflexes in 4 children who underwent spinal anesthesia for lower abdominal procedures. While initially thought to be the result of higher-than-intended spinal anesthesia, the observation that gentle stimulation produced vigorous phonation, orbicularis oculi constriction, and upper extremity movement suggests an alternative mechanism. This finding highlights a potential gap in knowledge related to the effect spinal anesthesia has on brain dynamics in children.
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Patients with anterior mediastinal masses pose a significant challenge to anesthesiologists. Catastrophic outcomes have been described in patients with mediastinal masses undergoing anesthesia. However, despite an abundance of literature discussing anesthetic management of these patients, there is a lack of reports detailing the management of this population undergoing advanced endoscopic procedures under sedation. We report on a 28-year-old man with a large anterior mediastinal mass who underwent endoscopic retrograde cholangiopancreatography in the prone position under moderate to deep sedation without complication.
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A 78-year-old woman complained of numbness, tingling, and pain in the left leg 6 months after greater saphenous vein stripping. Ultrasonography identified a mass adjacent to the saphenous nerve at the scar. Ultrasound-guided hydrodissection separated the mass from the nerve. ⋯ The visual analog pain scale decreased from 80 (before treatment) to 60 three days later. The hydrodissection was repeated weekly for a total of 8 times, and the pain completely resolved 4 months later. Ultrasound-guided hydrodissection is effective to treat nerve entrapment after lower extremity varicose vein stripping.
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Cytoreductive surgery (CS) and hyperthermic intraperitoneal chemotherapy (HIPEC) present a challenging task for anesthesia providers. Anesthesia management may be complicated by hyperthermia, fluid shifts, and distinct inflammatory response. ⋯ We report a case of a 2-year-old child with a relapse of an alveolar rhabdomyosarcoma of the uterus and peritoneal carcinomatosis treated with CS and HIPEC. For children, careful temperature measurement, intraoperative prevention of hyperthermia, and sufficient volume management are important, as well as postoperative pediatric intensive care with experience CS and HIPEC patients.
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Tracheobronchomalacia is a weakness of the trachea and bronchi due to abnormal cartilage and muscular support leading to airway obstruction. We report a case of an adult former smoker without pulmonary symptoms who underwent robotic-assisted laparoscopic cystectomy in the steep Trendelenburg position. ⋯ Tracheomalacia is an underdiagnosed condition in patients with a smoking history and may mimic other obstructive diseases. The anesthesiologist should remain vigilant to the possibility of airway collapse in former smokers, specifically in cases of increased intrathoracic pressure.