A&A practice
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Case Reports
Point-of-Care Ultrasound for Gastric Volume Measurement in a Pediatric Patient-Look Beyond the Antrum: A Case Report.
Gastric ultrasound estimates stomach contents in perioperative patients. A 10-year-old boy with abdominal rhabdomyosarcoma, who received abdominal radiation, developed gastroparesis and was scheduled for endoscopic gastrointestinal pyloric dilation. Point-of-care gastric ultrasound revealed gastric antral cross-sectional area of 6.5 cm2 (estimated gastric content ~30 mL). ⋯ On induction ~125 mL of stomach contents was suctioned. Antral measurements may not accurately predict the stomach contents in the setting of a stiff/fixed antrum. Scanning from antrum to fundus determined contents more accurately, especially with a prior history of abdominal radiation.
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Referred chronic shoulder pain may arise from diaphragmatic irritation. It can potentially be alleviated by blockade of the phrenic nerve. ⋯ Patients experienced significant pain relief and a reduction in opioid consumption after receiving an ultrasound-guided phrenic nerve block. While the phrenic nerve block shows promise for pain relief, carefully evaluating its benefits and risks is recommended before considering its application in selected cases.
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Case Reports
Adductor and Sciatic Peripheral Nerve Catheters for Schatzker VI Tibial Plateau Fracture: A Case Report.
Peripheral nerve blocks are typically avoided for high-speed tibial plateau fractures due to their ability to mask the paresthesias and pain associated with the feared complication of acute compartment syndrome (ACS). We present a case in which sciatic nerve and adductor canal catheters were placed utilizing low-volume infusions allowing for neurovascular assessment. These catheters served as a valuable portion of the multi-modal pain regimen in this patient with a Schatzker VI tibial plateau fracture.
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Case Reports
Opioid-Obviating Analgesia for Adolescent Multilevel Spinal Fusion Surgery: A Problem-Based Learning Discussion.
A female teenager with a history of polysubstance use, including a recent overdose, is scheduled for multilevel posterior spinal fusion surgery due to idiopathic scoliosis and has asked to avoid the use of opioids in the context of her upcoming surgery. This problem-based learning discussion (PBLD) focuses on the examination of the care of a spinal fusion patient that allowed for the successful provision of opioid-obviating care.
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Primary encephaloceles are congenital mesodermal defects that result in brain tissue protruding through the skull. These defects most commonly occur occipitally but can be present anywhere in the calvarium. ⋯ Basal meningoencephaloceles with cleft palate defects are the rarest form, with very few reports discussing anesthetic implications. We report a case of a giant basal meningoencephalocele that involves the nasal and oral cavities with a risk of thecal sac rupture.