A&A practice
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Review Case Reports
Hereditary Angioedema in Pregnancy: A Case Report and Review of Obstetric Anesthesia Management.
Hereditary angioedema (HAE) is a rare disorder due to C1 esterase inhibitor deficiency, causing recurrent swelling. Pregnancy can exacerbate HAE due to estrogen fluctuations alongside peripartum stress and trauma. ⋯ Angioedema prevention involves timely anesthesia consultation, accessible emergency airway equipment, early neuraxial anesthesia, planned vaginal delivery, and 48 to 72 hours of close postpartum monitoring. Readily available C1-inhibitor and a multidisciplinary approach with these recommendations are crucial for peripartum management.
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Case Reports
A Case of a Cerebrospinal Fluid Leak Secondary to Chiropractic Manipulation of the Thoracic Spine.
Chiropractic spinal manipulation therapy (CSMT) of the cervical spine has been reported to cause mechanical dural injuries that result in cerebrospinal fluid (CSF) leaks. We present a case of symptomatic intracranial hypotension after isolated thoracic CSMT. ⋯ Multiple epidural blood patches were attempted, including image-guided approaches and with fibrin sealant, but surgical repair was ultimately required. Our case illustrates the risk of dural tear in the setting of recent CSMT and the challenges of managing such an injury.
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Dysphagia after anterior cervical spine surgery has a 5% to 15% incidence beyond 1-year postsurgery, often attributed to mechanical factors such as pharyngeal thickening and epiglottis inversion. Despite normal neurological examination and electromyography, nerve distortion related to stretching also remains a possibility in these patients and may cause allodynia resulting in odynophagia and dysphagia. Current treatment options for dysphagia after anterior cervical discectomy and fusion are limited to local intraoperative steroid injections and tracheal traction exercises. In our patient, a glossopharyngeal nerve block was effectively used to manage the glossopharyngeal allodynia, thereby reducing the odynophagia and dysphagia, ultimately enhancing oral tolerance.
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An esophageal bronchus is a subtype of congenital bronchopulmonary foregut malformations in which a lobar bronchus arises directly from the esophagus, creating a communication between the esophagus and lung tissue. Early diagnosis is crucial to prevent worsening pulmonary sequelae but is challenging due to the rarity of the anomaly and nonspecific respiratory symptoms. We present a child whose esophageal bronchus was identified incidentally during preanesthetic assessment for craniosynostosis repair and discuss the role an anesthesiologist can play in identifying and managing this diagnosis.
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Patients presenting with large ventral abdominal wall hernias require pretreatment with injection botulinum toxin A before surgery. Currently, multipoint and multilayered botulinum injection techniques are practiced. We are describing a new ultrasound-guided, 1-point, single interfascial plane botulinum toxin A injection technique for the closure of big hernial defects.