A&A practice
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This case report highlights a unique instance of spinal myoclonus after neuraxial anesthesia. It aims to inform anesthesiology providers, enhancing their ability to identify, manage, and potentially prevent similar outcomes in patients at risk.
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Thoracic epidural analgesia is commonly used for postoperative analgesia for abdominal and thoracic surgeries. One complication of thoracic epidural catheter placement is a malpositioned catheter, such as in the subarachnoid, subdural, or intrapleural space. ⋯ The catheter produced a sensory level and analgesic benefit and was only identified incidentally on computed tomography (CT) imaging. This case highlights another possible anatomic location for unintentional catheter placement, which may be more common than reported, as it functioned as an epidural catheter by all clinical metrics and would not have been identified without imaging.
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Transporting spontaneously ventilating adults with tracheostomies from the operating room (OR) or other anesthetizing locations to the intensive care unit (ICU) or other recovery locations presents significant challenges, as traditional T-pieces may not be readily available. This article describes a novel modification to the Ayre's T-piece, designed to address this gap by using readily available equipment. The modification integrates a 3-mL syringe, a size 7.0 endotracheal tube (ETT) connector, and oxygen tubing from an adult under-the-chin style facemask while adapting the expiratory and inspiratory limbs of the anesthesia circuit.