A&A practice
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Preoperative cardiac risk stratification algorithms typically use a Bayesian approach to identify a low-risk category group for which the outcome is unlikely to be improved by further testing. This report suggests evaluating common carotid intima-media thickness (CCIMT) as measured by ultrasound to determine whether it strengthens and optimizes perioperative Bayesian risk indices. ⋯ A website (www.suhitam.com/vascularage) designed by one of the authors (S. M.) is a useful resource.).
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Case Reports
Anesthetic Management of Posterior Sternoclavicular Joint Dislocations: A Report of 2 Cases.
Posterior sternoclavicular joint (SCJ) dislocation is a rare cause of shoulder injury that can present with life-threatening mediastinal complications. This injury most commonly occurs in adolescents and young adults, and there is a lack of anesthesia literature addressing its anesthetic implications. We present 2 cases of posterior SCJ dislocations and discuss the anesthetic management and the potential for mediastinal injuries.
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Case Reports
Epidural-Like Effects With Bilateral Erector Spinae Plane Catheters After Abdominal Surgery: A Case Report.
This case report highlights the potential for adverse effects with the erector spinae plane (ESP) blocks. ESP blocks are an alternative to the traditional epidural and paravertebral block for postoperative analgesia due to their relative technical ease and seemingly safer profile. To date, few complications have been reported from ESP blocks or catheters. Despite its distance from the epidural space, epidural-like effects may still occur with ESP catheters, such as hypotension and motor blockade, as observed in this patient after abdominal surgery.
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Point-of-care ultrasound is becoming increasingly utilized in centers throughout the country for use in perioperative regional anesthesia procedures, vascular access, diagnosis, and resuscitation. We propose an educational approach that not only spans the 4-year duration of anesthesia residency but also regularly assesses progress throughout training. We accomplish this through a flipped classroom model, in which the 12 residents in each class participate in online modules for the baseline didactic knowledge, then come to a session where they have the opportunity to work in small groups (1:2-1:3 ratio of faculty to learner) and practice the skills outlined in the modules.
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Case Reports
Spinal Cord Stimulator Placement in Patient With von Willebrand Disease: A Case Report.
Complex regional pain syndrome (CRPS) is a regional neuropathic pain syndrome. Excruciating pain often interferes with patients' ability to function normally. ⋯ Implantation of SCS is a high-risk interventional procedure with the potential for serious bleeding and neurological consequences in the spine. Meticulous evaluation and careful optimization are needed in patients with bleeding disorders.