A&A practice
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Chronic neck and upper back pain occurs in 40%-60% of patients that suffer whiplash injury. Increasing evidence points to a dysfunction of the cervical and thoracic muscles as the predominant cause of persistent pain in this cohort. ⋯ As a result, there is significant functional impairment leading to excessive health care costs. The authors present a novel treatment, intermediate cervical plexus block with depot steroids, in 3 patients presenting with refractory chronic neck and upper back pain from whiplash injury that produced durable analgesia and enabled return to employment.
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We present a case in which the Dräger Primus (Dräger Medical AG&Co KG, Lüberck, Germany) anesthesia monitor displayed false readings of low end-tidal carbon dioxide (EtCO2) immediately after intubation. The patient's physical examination, vital signs, and arterial blood gases were normal. ⋯ The defective monitor gas flow rates and gas calibration values were inappropriately low. Partial opening of the solenoid zero valve allowed entrainment of room air, which caused artifactual dilution of the gas sample.
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A 70-year-old Jehovah's Witness was treated with iron carboxymaltose intravenously, recombinant human erythropoietin alpha subcutaneously, and vitamin B12 and folate orally for 9 weeks to raise hemoglobin (Hb) from 10.8 to 17.0 g/dL before explantation of an infected hip joint prosthesis. The target Hb was calculated from the following formula: Hbtarget = Hbfinal/(1 - ABL/EBV), where Hbtarget= Hb to achieve before surgery, Hbfinal = lowest Hb patient could tolerate taking into consideration his comorbidities (7 g/dL), ABL = volume of blood the surgeon estimated the patient would lose intra- and postoperatively (3000 mL), and EBV = estimated blood volume (75 mL/kg for an adult man). Spinal anesthesia was provided with a single shot hyperbaric bupivacaine and fentanyl. ⋯ Surgical blood loss was estimated to be 2500 mL. Hb at the end of surgery was 13.3 g/dL; on postoperative day 5, 11.7 g/L. No blood products were utilized.
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Thoracolumbar interfascial plane block (TLIPB) has recently been described for postoperative analgesia after thoracolumbar spine surgery. This block is minimally invasive, relatively safe, and easy to perform. ⋯ We describe the sonoanatomic landmarks of this technique, and we report results of this retrospective case series on analgesic impact of this block in patients undergoing implantation of spinal cord stimulation systems. Clinical studies are required to investigate the analgesic role of TLIPB for spinal thoracolumbar surgery.
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Near-infrared spectroscopy (NIRS) is a noninvasive monitor of regional brain tissue oxygenation, and jugular venous oximetry (SjvO2) is a monitor of global cerebral oxygenation. We report the role of intraoperative multimodal monitoring of cerebral oxygenation in the anesthetic management of a patient with grade III intracranial arteriovenous malformation (AVM) presenting for surgical excision. Real-time monitoring of cerebral oxygenation is of much relevance in high-grade AVMs where anesthetic management is focused on neuroprotection and prevention of cerebral hypoxia. Besides, it also helps in prediction, early detection, and judicious management of perioperative complications, which are commonly encountered in high-grade AVMs.