A&A practice
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Case Reports
Regional Anesthesia Management in a Fontan Patient Presenting for Ambulatory Shoulder Surgery: A Case Report.
Interscalene blocks, commonly used for shoulder surgery analgesia, often cause transient phrenic nerve palsy, leading to hemi-diaphragmatic paresis. This complication is particularly problematic in patients with pulmonary comorbidities and has been extensively investigated. ⋯ Hemi-diaphragmatic paresis can significantly reduce negative pressure spontaneous ventilation, leading to decreased venous return and increased pulmonary vascular resistance, which critically affects cardiac output. This case report explores regional anesthesia management in a Fontan patient undergoing shoulder surgery, emphasizing the suprascapular nerve block as an effective alternative for ambulatory patients.
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Case Reports
Does the Diagnosis of Intraoperative Malignant Hyperthermia Require Case Termination? A Case Report.
Malignant hyperthermia (MH) is a rare genetic disorder triggered by inhalational anesthetics or depolarizing neuromuscular blocking agents that carries significant mortality if not promptly treated. The following case presents a healthy 39-year-old man who developed MH several hours into an anesthetic exposure. Rapid intraoperative stabilization tactics that paralleled intensive care unit (ICU) level care allowed for continuation of operative management as opposed to case termination given the patient was at high risk for permanent nerve palsy if the case were to be aborted during dissection.
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Case Reports
Digital Ischemia Secondary to Ulnar Artery Puncture Successfully Treated by Brachial Plexus Block: A Case Report.
After vascular puncture and catheterization, arteries can have many complications that impede blood flow such as vasospasm, thrombosis, and emboli generation, among other complications. Treatment depends on severity of ischemic symptoms and can range from as mild as applying local heat packs to surgical thrombectomy. We present a case of digital ischemia secondary to vascular puncture that was successfully treated with a supraclavicular nerve block, resulting in the vascular surgery team canceling an emergent surgery.
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We report a case of a parturient with severe cardiac disease requiring elective termination of pregnancy. The patient underwent successfully monitored anesthesia care using remimazolam for dilation and curettage. ⋯ Remimazolam is an ultrashort acting benzodiazepine that is being used with increasing frequency in short procedures requiring sedation. Patients with complex cardiac comorbidities undergoing surgical procedures may receive maximum benefit from this novel medication due to its stable hemodynamic profile and rapid metabolism.
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Case Reports
Spinal Anesthesia in Elderly Patients With Femoral Neck Fractures on Apixaban Therapy: A Case Series.
This case series reviews surgeries involving elderly patients with femoral neck fractures on apixaban who underwent spinal anesthesia (SA) within 72 hours of their last dose. Despite patients being on anticoagulation, no neurological complications occurred, suggesting SA may be practical in cases where the benefits of timely surgery outweigh the potential risks, including apixaban discontinuation for a period of less than the recommended 72 hours with detectable levels of the drug remaining in the plasma. Quantitative apixaban measurements offered useful anticoagulation status insights, though safe thresholds remain undefined.