A&A practice
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A patient with end-stage amyotrophic lateral sclerosis (ALS) presented for Baclofen pump replacement. She underwent a left transversus abdominis plane block to anesthetize the left lower quadrant of the abdomen. ⋯ It is prudent to consider anesthetic plans that avoid complications associated with general or neuraxial anesthesia in patients with ALS. This case report demonstrates successful placement of a transversus abdominis plane block in a patient with ALS and offers a safe anesthetic technique that can be performed in other high-risk patients.
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Pupillary unrest in ambient light (PUAL), the normal pattern of pupil diameter fluctuation present in awake humans, has been proposed as a marker of central opioid effect. We report 2 cases in which PUAL identified the appropriate pain management for 2 patients, each with unique, challenging acute pain conditions. In both cases, PUAL accurately predicted opioid responsiveness, suggesting an effective, individualized analgesic approach for both patients.
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Managing the airway of an infant with Pierre Robin sequence (PRS) is particularly challenging for anesthesiologists. Patients with PRS have the triad of micrognathia, glossoptosis, and airway obstruction that potentially and frequently leads to difficulty with both ventilation and intubation. Thus continuous oxygenation and spontaneous ventilation during intubation are essential. We describe a new method to deliver continuous oxygen and volatile anesthetic during nasotracheal intubation in an infant with PRS.
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The use of spinal cord stimulator (SCS) treatment has been particularly effective as an adjunct in treating mixed neuropathic, nociceptive, and radicular pain conditions. There are no published studies on the use of SCS for chronic pain syndrome after laparoscopic cholecystectomy. We successfully used an SCS on a 31-year-old woman with a 4-year history of intractable right-sided subcostal pain after laparoscopic cholecystectomy. This case provides strong evidence that SCS should be considered as a treatment option for chronic postsurgical pain after laparoscopic cholecystectomy not amenable to standard therapies.