A&A practice
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Case Reports
Scapular Block: An Innovative Procedure-Specific Regional Anesthesia Technique for Scapula Surgery-A Case Report.
A 40-year-old healthy male patient underwent open reduction and internal fixation with screws and plate for a comminuted fracture of the right scapula under ultrasound-guided "scapular block" with optimal sedation. We coined the term "scapular block" for an innovative combination of previously described regional anesthesia techniques to cover all dermatomes, myotomes, and osteotomes involved in scapula surgery. It is a combination of 5 target blocks (selective superior trunk block, selective supraclavicular nerve block, subclavian perivascular block, suprascapular nerve block, and erector spinae plane block) via 3 approaches (interscalene, supraclavicular, and paraspinal).
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This single-center retrospective study evaluated a protocol for the intubation of patients with confirmed or suspected coronavirus disease 2019 (COVID-19). Twenty-one patients were intubated, 9 of whom were found to have COVID-19. ⋯ COVID-19 patients had lower peripheral capillary oxygen saturation by pulse oximetry (Spo2) nadirs during intubation (Spo2, 73% [72%-77%] vs 89% [86%-94%], P = .024), and a greater percentage experienced severe hypoxemia defined as Spo2 ≤80% (89% vs 25%, P = .008). The incidence of severe hypoxemia in COVID-19 patients should be considered in the development of guidelines that incorporate high-flow nasal cannula and noninvasive positive pressure ventilation.
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Tracheomediastinal fistula (TMF) is an uncommon condition and carries a high mortality. We report the anesthetic management of a patient with TMF using stent insertion via rigid bronchoscopy. ⋯ Initial intraoperative attempts to ventilate the lungs and overcome the air leak with high gas flow of 45 L/min via the side port of the bronchoscope resulted in a pneumothorax. This case report demonstrates that high-frequency jet ventilation can minimize the air leak and avoid barotrauma during anesthesia for TMF repair.
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Phantom limb pain is a common condition occurring after amputations. Percutaneous peripheral nerve stimulation (PNS) has been reported to provide analgesia for established lower extremity phantom pain. ⋯ A percutaneous PNS lead placed adjacent to the patient's brachial plexus under ultrasound guidance provided analgesia of the phantom pain for several weeks. PNS of the brachial plexus may provide analgesia for patients with upper extremity phantom pain.