A&A practice
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Case Reports
Autonomic Dysreflexia After Hip Fractures Managed by Regional Anesthesia: A Case Report.
Autonomic dysreflexia occurs after a spinal cord injury usually at the level of T6 or above, and its hallmark feature is exaggerated autonomic response to noxious stimuli resulting in uncontrolled hypertensive episodes with reflexive bradycardia that can be fatal if not controlled. We present a case highlighting regional anesthetic techniques, including peripheral nerve blocks, to ameliorate the symptoms of autonomic dysreflexia triggered by hip fractures in a 57-year-old woman with an old C5-C6 spinal cord injury before definitive hip surgery. The regional techniques described provide anesthesiologists with a simple strategy to potentially mitigate a life-threatening situation.
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Bleomycin is a cytotoxic antibiotic that has a sclerosing effect on vascular endothelium. Small doses can be injected locally to reduce the size of various vascular malformations. ⋯ On review of cases performed following protocol implementation, no patients developed hyperpigmentation attributable to iatrogenic skin trauma. We present our bleomycin skin protection protocol to guide peer institutions in the initiation of similar quality improvement initiatives.
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Hip arthroscopy is often associated with postoperative pain, requiring opioid analgesia. We describe our use of the pericapsular nerve group (PENG) block as a rescue analgesia for hip arthroscopy. ⋯ All patients exhibited good pain control without clinically significant quadriceps weakness and were able to go home the same day. This case report illustrates the possibility of using the PENG block as an alternative to more conventional regional nerve blocks, such as a fascia iliaca block, femoral nerve block, or lumbar plexus block.
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Ear pain is mediated by cranial nerves V, IX, and X, as well as branches of C2 and C3, including the occipital nerve. Occipital neuralgia may play a role in the development or worsening of tinnitus and otalgia. The authors reviewed and report 33 cases of ultrasound-guided occipital nerve blocks in patients with tinnitus and otalgia, with postprocedure follow-up intervals of up to 2 years. We found that greater occipital nerve blocks may be a valuable treatment method for these patients.
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We present a 67-year-old woman who was hemodynamically stable with radiographic evidence of saddle pulmonary embolism (PE) in the main pulmonary artery and mobile thrombus in the right heart. Endovascular thrombectomy was scheduled under general anesthesia. Before anesthesia induction, femoral vessel access was planned under local anesthesia in case emergent cardiopulmonary bypass (CPB) was needed. ⋯ Transesophageal echocardiography (TEE) confirmed acute massive PE. CPB was emergently established. Surgical embolectomy was conducted with successful outcome.