A&A practice
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The outcome of upper limb tendon transfer surgery is improved when the patient is able to voluntarily contract specific muscles during the surgical procedure. Tumescent local anesthesia is suitable, but we describe an alternative option that involves the novel management of an axillary block. A 47-year-old man, injured in a motor vehicle crash, exhibited a thumb extensor deficit because of severe muscular trauma to the forearm. ⋯ First, individual injections of ropivacaine were performed around the musculocutaneous, radial, and ulnar nerves with ultrasound guidance. Second, a perineural catheter was placed near the median nerve and lidocaine injected. Voluntary flexor muscle contraction reappeared in time for the surgeon to adjust his suture tension.
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Transnasal humidified rapid-insufflation ventilatory exchange is a recently described technique for safer management of difficult airways and a novel ventilation technique under anesthesia. Its full potential in patient safety and benefits are still being investigated. ⋯ However, we advocated deep IV sedation with transnasal humidified rapid-insufflation ventilatory exchange. Oxygenation was maintained without airway obstruction and pulmonary complications during the entire procedure of 110 minutes.
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Local anesthetic toxicity is a rare but serious complication of local anesthetic administration. Although lidocaine has a safety profile superior to other amide local anesthetics, we report a case of cardiac arrest after intranasal injection of lidocaine. ⋯ Resuscitative efforts were unsuccessful until a bolus of intralipid was given. This case emphasizes that even a "low" dose of a less lipophilic drug has the potential for severe toxicity.
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Local anesthetics are used throughout the health care system. In the perioperative setting and in other settings of exposure to local anesthetics, true allergy is reported very rarely. ⋯ This case illustrates that lidocaine may be a "hidden allergen" in the perioperative setting and should always be considered a potential culprit in cases of suspected perioperative hypersensitivity. The case also demonstrates that suspected perioperative hypersensitivity requires highly specialized investigation and close collaboration between allergists and anesthesiologists.
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Mirror syndrome is a rare pregnancy complication, life-threatening to mother and fetus. Increasing survival rates of congenital heart disease into reproductive age mean that complications like Mirror syndrome in this population may be more challenging to diagnose, given overlapping signs of edema in cases of heart failure exacerbation. ⋯ A cesarean delivery under neuraxial anesthesia was performed. We review the clinical manifestations of Mirror syndrome and discuss anesthetic and obstetric management considerations for this condition.