A&A practice
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Case Reports
Traumatic Tracheobronchial Laceration Causing Complete Tracheal Resection: Challenges of Anesthetic Management.
We report the case of a 9-year-old girl who sustained blunt trauma to the chest and presented for emergent repair of a complete tracheobronchial laceration. Tracheobronchial laceration is potentially life threatening. While conservative management has been described for simple tears, more complex injuries require surgical repair. We discuss the anesthetic challenges, airway management, and ventilation options for surgical repair in a child with a complex laceration involving the tracheobronchial tree.
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Case Reports
Anesthesia for Pygopagus Conjoined Twins During Single-Twin and Simultaneous Pneumoperitoneum: A Case Report.
We present the case of the first stage of separation of 9-month-old pygopagus conjoined twins who demonstrated minimal shared vasculature on preoperative imaging and no cross-sedation or cross-neuromuscular blockade during separate inductions of anesthesia. Laparoscopy was implemented in 1 twin at a time, then in both twins simultaneously. Despite insufflation of a single-twin's abdomen, both twins demonstrated hypercapnia and signs of a concomitant respiratory acidosis because of carbon dioxide diffusion through a shared peritoneal membrane. This is the first documented case of simultaneous laparoscopy-induced pneumoperitoneum in pygopagus conjoined twins.
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Severe pain after a hip fracture commonly delays hospital discharge and poses significant nursing problems in patients who are not surgical candidates. We present ultrasound-guided pericapsular hip alcohol neurolysis of the articular branches of the femoral and obturator nerves as a novel approach in the treatment of severe pain after hip fracture. This technique provided excellent pain relief in a 94-year-old patient with intertrochanteric hip fracture until her death 2 months later.
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Case Reports
Transversalis Fascia Plane Block for the Treatment of Chronic Postherniorrhaphy Inguinal Pain: A Case Report.
Chronic neuropathic pain is a well-recognized complication of inguinal hernia repair. We report a 47-year-old man suffering from chronic neuropathic postherniorrhaphy pain. ⋯ We therefore performed transversalis fascia plane block with local anesthetic and steroid that resulted in long-term pain relief. This block has been successfully used in the past for providing postoperative analgesia in the L1 dermatome, but its role in chronic pain is unreported.
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Baastrup disease is a condition where spinous processes form painful pseudoarticulations. We present a patient with midline axial back pain consistent with Baastrup disease confirmed by computed tomography, which revealed degenerative changes along the opposing surfaces of the spinous processes at L1-2 and L2-3. ⋯ She underwent successful interspinous radiofrequency lesioning, which has not been previously described in the literature. At 4 months follow-up, she reported complete pain relief.