A&A practice
-
Sugammadex, given its high affinity for amino-steroid neuromuscular blockers, offers rapid and reliable neuromuscular blockade reversal, making it a popular reversal agent. This characteristic can be very useful in pregnant women, where incomplete reversal can have poor maternal and fetal outcomes. However, its use antenatally in pregnancy is controversial given concerns for progesterone binding, a hormone that is crucial for maintenance of pregnancy. This case series presents obstetric and fetal outcomes in 25 pregnant women who received sugammadex during the antenatal period, thus highlighting the need for further research into the safety of sugammadex during pregnancy.
-
In this case report, we described the use of the continuous erector spinae plane (ESP) block in a patient presenting with severe chest wall pain due to terminal metastatic breast cancer. Her pain was refractory to most treatment modalities despite being on huge doses of parenteral opioids for 6 months. ⋯ This was followed by an ESP catheter insertion and continuous infusion of local anesthetic, which helped her wean off the parenteral opioids over the next 4 days. She was discharged home with the catheter in situ, attached to a delivery pump.
-
Case Reports
Bloodless Management of Severe Obstetric Hemorrhage With Very Severe Anemia: A Case Report.
This case report describes bloodless management of a 32-year-old Jehovah's Witness who had severe obstetric hemorrhage at 23 weeks of gestation, spontaneously delivering twin fetuses. After resuscitation with crystalloids and colloids, the patient was still bleeding and hemoglobin fell to 3.3 g/dL. She had emergency hysterectomy. ⋯ She regained consciousness and received intravenous iron and erythropoietin. She recovered fully without complications and without blood transfusion. Hemoglobin at discharge (postoperative day 18) was 6.9 and 12.5 g/dL 4 months later.
-
The Internet is a source of professional self-education for medical students and residents. Unfortunately, much of the content discovered through search engines is of insufficient quality for professional education. ⋯ As of March 2020, 64 anesthesiology residency programs in the United States subscribed to the AT (41% of total). Since the onset of the pandemic in March, AT has added 25 programs (28% increase) and gained 1156 users (26% increase).
-
The coronavirus disease 2019 (COVID-19) pandemic prompted the creation of novel techniques to protect patients and health care providers. Simulations showed that disposable oxygen face tents act as a physical barrier and can be repurposed as a negative airflow tent. ⋯ Precautionary measures were taken by means of full personal protective equipment (PPE) and negative airflow tent. The tent added additional protection and is a promising new technique that is disposable, widely available, and offers full access to proceduralists.