A&A practice
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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.
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Accurate self-assessments enhance learning and patient care, yet resident physicians self-assess poorly. We therefore tested the effects of a consider-the-opposite (CTO) cognitive debiasing technique on self-assessment accuracy among anesthesiology residents. ⋯ Communication/leadership self-assessment accuracy improved by 5.63% (95% CI 0.001%-16.9%), but this did not meet our prespecified threshold for a meaningful effect. These findings do not suggest a compelling effect of this CTO intervention on self-assessment accuracy among trainees.
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Management of refractory ventricular fibrillation (VF) in patients with implantable implantable cardioverter defibrillator (ICD) presents a therapeutic challenge. We present a case of pediatric refractory ventricular tachycardia (VT)/Torsade de Pointe managed effectively with bilateral stellate ganglion block (SGB) with a long-acting local anesthetic for 18 days as a bridge to more definitive surgical management.
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This case report describes a 29-year-old patient with cerebral palsy whose mother, for safety reasons, requested that before extubation in the postanesthesia care unit, her son be transferred from the padded stretcher to his personal motorized wheelchair. Using a sling lift, we safely transferred the anesthetized, intubated patient from a supine position to an upright sitting position. Although sling lifts are often used in critical care and rehabilitation environments, use in the perioperative space is rare. In this case report, we demonstrate how a sling lift can enhance safety for patients and perioperative staff.