A&A practice
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Randomized Controlled Trial
Hip Fracture Intervention Study for Prevention of Hypotension Trial: a Pilot Randomized Controlled Trial.
Hypotension during anesthesia for surgery for hip fracture is common and associated with myocardial injury, stroke, acute kidney injury, and delirium. We hypothesized that maintaining intraoperative blood pressure close to patients' preoperative values would reduce these complications compared to usual care. ⋯ A randomized controlled trial of tight intraoperative blood pressure control compared to usual care to reduce major postoperative complications after fractured neck of femur surgery is possible. However, the data would suggest a large sample size would be required for a definitive trial.
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An elderly patient with renal cell carcinoma underwent a robotic nephrectomy. After an uneventful intraoperative period, soon after extubation she developed generalized seizures and was diagnosed with posterior reversible encephalopathy syndrome (PRES) on neuroimaging. ⋯ PRES was attributed to compromised renal function, chronic hypertension, and the effects of pneumoperitoneum. Early diagnosis, aggressive treatment, and rehabilitation are crucial for the management and recovery of patients with PRES.
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The Accreditation Council for Graduate Medical Education defines "nonphysician obligations" as "duties performed by nursing and allied health professionals, transport services, or clerical staff." How anesthesiology trainees understand the concept of "nonphysician obligations" and are impacted by these obligations is incompletely understood. The objective of the study was to identify how anesthesiology trainees define "nonphysician obligations," which obligations impact trainee education, and what attitudes trainees hold. ⋯ "Nonphysician obligations" are defined by a new, nuanced, specialty-specific explanatory framework, and those that impact education are summarized in distinct classes. Trainee definitions and attitudes expose possible faults in how nonphysician obligations are currently evaluated.
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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
Prolonged Treatment of Inappropriate Sinus Tachycardia with Continuous Stellate Ganglion Blockade: A Case Report.
Inappropriate sinus tachycardia (IST) presents challenges in diagnosis and treatment due to its unclear etiology and limited therapeutic options. This case report explores the use of continuous stellate ganglion block (CSGB) as a potential treatment avenue. ⋯ Despite the eventual recurrence of symptoms, the sustained effects of CSGB suggest its efficacy in managing IST. This report underscores the potential of CSGB as a promising therapeutic approach for IST, offering longer-lasting symptom control compared to single-injection stellate ganglion block (SGB) interventions.