A&A practice
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Case Reports
A Case Report of a Pericapsular Nerve Group Block for Transcatheter Aortic Valve Implantation.
A pericapsular nerve group (PENG) block is an interfascial plane block that targets the articular branches of the femoral and obturator nerves. PENG blocks may be used for hip, vein, and groin surgeries. ⋯ A PENG block using a high volume of local anesthetics may be as effective as a lumbar plexus block. In this case report, we describe successful anesthesia management using PENG blocks in 2 patients who underwent TAVI.
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We present a case of a 12-year-old female with a history of infantile spasms who developed a propofol-associated acute dystonic reaction after emergence from general anesthesia for foot surgery. Uniquely, the patient's postoperative symptoms of an acute dystonic reaction were refractory to standard treatment with anticholinergics but were successfully treated with corticosteroids. The absence of any dystonic symptoms following subsequent foot surgery under general anesthesia without propofol supported a propofol-associated etiology. This case may contribute to a better understanding of the underlying mechanisms of propofol-associated acute dystonic reactions and adds a possible new treatment option.
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A 39-year-old woman with juvenile idiopathic arthritis complicated by nonuremic calciphylaxis presented for pain management of bilateral lower extremity wounds requiring frequent dressing changes. Bilateral single-shot femoral nerve blocks using liposomal bupivacaine and 0.25% bupivacaine were performed. ⋯ Repeat, bilateral single-shot femoral nerve blocks with liposomal bupivacaine and 0.25% bupivacaine were performed approximately every 72 hours to maintain adequate analgesia. We conclude that off-label use of liposomal bupivacaine in femoral nerve blocks results in prolonged block duration without adverse effects or tachyphylaxis.
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Case Reports
Intraoperative Diagnosis of Bilateral Upper Limb Arteriovenous Fistulae in a Child: A Case Report.
Arteriovenous fistulae have not been extensively reported in pediatric patients and are rare for pediatric anesthesiologists to encounter in their routine practice. Awareness of these lesions enables clinicians to avoid giving medications through the anomalous vascular connections. We report a child scheduled for an excision of a sacrococcygeal mass in whom we incidentally diagnosed the presence of arteriovenous fistulae in both his upper limbs. The affected limbs should be avoided and the vessels of the lower limbs should be cannulated for administration of fluid and medications during surgery.
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Anesthesiologists should be aware of the coagulation implications of therapeutic plasma exchange (TPE) with albumin replacement for desensitization of kidney transplant (KT) recipients. We describe a case where the final preoperative TPE was performed with albumin. ⋯ Thereafter, fibrinogen contribution to clot strength normalized, coinciding with clinical hemostasis. With the increased use of TPE to reduce antibodies in KT recipients, visco-elastic testing may assist in the identification of coagulation defects when plasma is not used as replacement fluid.