A&A practice
-
Providing effective analgesia for acute rib fractures is crucial in avoiding pulmonary complications. Erector spinae plane (ESP) block is an alternative treatment option to neuraxial techniques. ⋯ However, the utilization of unilateral bilevel ESP catheters has not been described. We present a case of unilateral bilevel ESP catheters placed in a patient with flail chest secondary to a motor vehicle accident.
-
Case Reports
Residual Weakness and Recurarization After Sugammadex Administration in Pediatric Patients: A Case Series.
While shown to be safe for administration in pediatric patients, sugammadex has recently been associated with residual weakness or recurarization. We describe 4 additional cases of pediatric patients with residual or recurrent weakness following rocuronium reversal with sugammadex. ⋯ A third patient received sugammadex with apparent waning of clinical effect and subsequently required neostigmine reversal. A fourth patient was observed to have residual weakness, which led to prolonged intubation despite appropriate train-of-four results after reversal with sugammadex.
-
We report weaning from mechanical ventilation with no coughing in a patient with coronavirus disease 2019 (COVID-19). Substituting the endotracheal tube for a supraglottic airway (SGA), which is less stimulating to the trachea, can reduce coughing with weaning from mechanical ventilation and extubation. Personal protective equipment is in short supply worldwide. Reducing spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is beneficial in terms of occupational health of health care workers.
-
The coronavirus disease 2019 (COVID-19) pandemic created an unprecedented need for mechanical ventilation in critically ill patients. To meet this increased demand, some facilities were forced to use anesthesia gas machines (AGMs) as intensive care unit (ICU) ventilators. While an off-label use, AGM manufacturers, the Anesthesia Patient Safety Foundation, and the American Society of Anesthesiologists have guidelines for AGM use in the ICU, however, there is scant literature describing their use. This article describes our experiences at New York University Langone Medical Center using AGMs in the ICU for ventilating critically ill COVID-19 patients.
-
Propofol is a sedative and a hypnotic agent used in the induction and maintenance of general anesthesia. Propofol also relaxes skeletal muscles. ⋯ Our case report describes a 25-year-old patient with painful spastic cerebral palsy, who experienced prolonged improvement of his symptoms after treatment with propofol. The patient has received 13 administrations of propofol with similar efficacy each time.