A&A practice
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Case Reports
Sphenopalatine Ganglion Blocks in the Management of Head and Neck Cancer-Related Pain: A Case Series.
Head and neck cancer can be painful, debilitating, and refractory to oral medications. Due to the association of the sphenopalatine ganglion (SPG) with maxillary nerve sensory fibers, SPG blocks may be used to treat the pain of the hard and soft palate, tonsils, nasal cavity, paranasal sinuses, oral gingiva, premaxillary soft tissue, maxilla, and orbital floor. We present the first case series of performing SPG blocks utilizing TX360 nasal atomizers or angiocatheters to treat head and neck cancer-related pain. Pain scores were reduced by 38% to 80% with an average pain relief duration of 23 days.
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Case Reports
Gastric Ultrasound Imaging to Direct Perioperative Care in Pediatric Patients: A Report of 2 Cases.
Pulmonary aspiration of gastric contents carries significant risk in children in the perioperative period. Ultrasound imaging of the gastric antrum has been validated to predict gastric content and volume in both pediatric and adult patients, and yet clinical applications in pediatric patients are sparse. We report 2 cases of children presenting for elective surgery with uncertain volume of gastric contents. Bedside gastric imaging successfully identified "full stomachs," and the information was used to direct care.
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The angle correction feature in ultrasound systems is used when there is difficulty accurately aligning the Doppler beam with the flow to be interrogated. The operator can manually "correct" the angle to the actual direction of flow. ⋯ We present a case of aortic valve replacement (AVR) in which falsely high transaortic gradients were obtained immediately after separation from cardiopulmonary bypass (CPB). We recommend that there be a more prominent notification when the angle correction feature is used with machine prompts confirming when a peak velocity is obtained using angle correction.
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Spinal drain placement to prevent spinal cord ischemia during thoracic aorta surgery is a necessary yet complex undertaking in patients with coagulopathies. Thromboelastography (TEG) can be used as a point-of-care management tool to monitor coagulation status before drain placement and removal. We present 2 cases: a case of a patient with factor VII deficiency and a case of a patient with thrombocytopenia for whom TEG was an important procedural adjunct during coagulopathy reversal. TEG parameters are also discussed to encourage more frequent TEG use as an adjunct during these complex cases.