A&A practice
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Directed discussion about advanced care planning in the preoperative setting is often lacking. We implemented an educational intervention pilot to increase the number of high-risk patients who have health care proxy and advanced directives documents completed. ⋯ Survey results showed that majority of patients felt the intervention increased their knowledge about advanced care planning (65%-70%) and that the video raised some topics worth discussing with family and health care providers. This intervention is scalable and could improve documentation and quality of care.
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Case Reports
Spinal Cord Trauma During Subarachnoid Anesthesia for Cesarean Delivery: A Case Report.
Spinal cord trauma can occur during subarachnoid blockade and can result in significant morbidity for the patient. Careful attention to lumbar insertion level is essential to prevent injury.
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Cluster headaches are characterized by unilateral sudden onset of intense, brief, sharp pain along the side of the face around the eye. Patients often can have symptoms that are resistant to medications, nerve blocks, and surgical treatments. There is increasing evidence of anatomical and functional connections between the trigeminal and occipital nerves. We present a patient with cluster headache presenting with chronic ipsilateral facial pain with nasal congestion and left eye pain who achieved sustained pain relief with an ultrasound-guided injection into the pterygopalatine fossa in conjunction with an ultrasound-guided pulsed radiofrequency ablation procedure involving the C2 dorsal root ganglion.
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Feedback in clinical education is essential but challenged by multiple barriers. This report describes the use of myTIPreport, a web-based tool, which streamlines the dual purpose of milestone evaluation and real-time feedback from faculty to residents in a US anesthesiology program. In a 6-month trial, faculty members and residents used myTIPreport for daily clinical feedback. We believe myTIPreport will be a valuable tool for clinical feedback given further refinement of the tool and improved faculty and resident development on program use.
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Case Reports
Dexmedetomidine Sedation in Magnetic Resonance-Guided Focused Ultrasound Thalamotomy: A Case Series of 3 Patients.
Magnetic resonance-guided focused ultrasound thalamotomy is an innovative minimally invasive treatment for medication-resistant tremor in patients with essential tremor and Parkinson disease. Sedation with common hypnotic agents is discouraged because the patient's cooperation is required during the procedure, and these drugs interact with the patient's tremor, interfering with the results of intraprocedural neurological evaluations. Dexmedetomidine may be the best choice for sedation during magnetic resonance-guided focused ultrasound thalamotomy, which can be prolonged and poorly tolerated by the awake patient. We report the first use of dexmedetomidine for sedation in magnetic resonance-guided focused ultrasound thalamotomy in 3 patients: none of them experienced relevant hemodynamic changes or apnea.