A&A practice
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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.
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Symptomatic carotid artery disease stenosis warrants open surgical carotid endarterectomy (CEA). However, patients with continuous-flow left ventricular assist devices (CF-LVADs) present unique challenges when vasopressors and volume are used to maintain cerebral perfusion pressure after carotid cross-clamping. ⋯ We identify how preload, contractility, afterload, pump speed, mean arterial pressure, and anticoagulation should be addressed to maintain CF-LVAD outflow and cerebral perfusion during the procedure. Anesthesiologists can combine an understanding of continuous-flow physiology with invasive monitors to optimize cardiac output and cerebral blood flow during CEA procedures.
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Dynamic right ventricular outflow tract obstruction is rare in the cardiac surgical population. Significant obstruction developing in the perioperative period can contribute to systemic hemodynamic instability. ⋯ Both patients had systemic hypotension which improved once ventricular pacing was discontinued. We discuss the recognition of right ventricular outflow tract obstruction as a contributing factor to hemodynamic instability, as well as the importance of identifying the underlying cause such as to institute appropriate management in these patients.
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Thoracic fascial blocks have been included in multimodal analgesia for breast surgery. Fewer studies demonstrate its use as a regional anesthesia technique. The serratus anterior plane (SAP) block provides anesthesia to the lateral thoracic wall and the axilla, the surgical area of some breast surgeries, with a single injection. This article reports the use of the SAP block as an anesthetic technique for breast lumpectomy with axillary dissection ensuring good surgical conditions and patient safety.
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Morbidity and mortality associated with the pandemic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease (coronavirus disease 2019 [COVID-19]) are not only due to acute respiratory distress syndrome but also related to multiorgan involvement and dysfunction. In this report, we present a critically ill patient with severe COVID-19 pneumonia, during which he required extracorporeal membrane oxygenation and suffered from multiple complications. Bedside sonography became an important tool to manage the patient by adapting artificial ventilation parameters and played a key role in the diagnosis of thrombotic events and the monitoring of subarachnoid hemorrhage that unexpectedly complicated the case.