A&A practice
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Chronic abdominal pain is common in children and adolescents but challenging to diagnose, because practitioners may be concerned about missing serious occult disease. Abdominal wall pain is an often ignored etiology for chronic abdominal pain. ⋯ Correctly diagnosing patients with anterior cutaneous nerve entrapment syndrome is important because nerve block interventions are highly successful in the remittance of pain. Here, we present the case of a pediatric patient who received a diagnosis of functional abdominal pain but experienced pain remittance after receiving a trigger-point injection and transverse abdominis plane block.
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A 36-year-old African American with a medical history of nonanesthesia-related malignant hyperthermia (MH) who was taking chronic oral dantrolene therapy presented with right upper quadrant pain for a laparoscopic cholecystectomy. A multidisciplinary perioperative plan was implemented with the goal of avoiding triggering an MH episode or rhabdomyolysis. He developed a postoperative left brachial vein thrombus of unclear etiology, possibly related to dantrolene administration or his underlying susceptibility to MH.
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Venovenous extracorporeal membrane oxygenation (VV-ECMO) is a well-established alternative oxygenation method for critically ill patients. A 58-year-old male was transferred to our level 1 trauma and burn center after sustaining an inhalational injury from a carburetor explosion, with subsequent iatrogenic tracheal injury and emergent cricothyrotomy before arrival. ⋯ Intraoperative VV-ECMO enabled rescue from severe hypoxemia and subsequent recovery without lasting neurologic sequelae. This case highlights the utility of VV-ECMO for acute intraoperative rescue.
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We present the case of a 55-year-old woman undergoing a delayed latissimus dorsi flap breast reconstruction after a simple mastectomy for breast cancer. Preoperatively, 2 unilateral paravertebral catheters were placed at T3/4 and T7/8 for postoperative analgesia. ⋯ The patient had excellent postoperative analgesia and required no opioids or other analgesics through postoperative day 10. We report that multilevel paravertebral nerve blockade could represent an opioid-sparing alternative for postoperative analgesia for latissimus dorsi flap breast reconstruction patients.
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Patients with severe pulmonary hypertension (PHT) represent a high-risk population when undergoing noncardiac surgery. During thoracic surgery with 1-lung ventilation, atelectasis of the operative lung, and frequently associated hypoxemia, is likely to exacerbate PHT and precipitate acute right ventricular failure. ⋯ After successful resuscitation in the operating room, she subsequently required prolonged venoarterial extracorporeal membrane oxygenation. Focused transthoracic echocardiography to evaluate cardiac function was critical in the diagnosis of PHT and subsequent treatment with sildenafil and nifedipine when discharged from the hospital.