A&A practice
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The use of supraglottic airway devices such as the King LTS-D laryngeal tube has increased in the prehospital setting because of their relative ease of successful insertion, even in the hands of inexperienced providers. However, these devices have their own associated complications. In patients with a known or suspected difficult airway, supraglottic airway device exchanges should occur under controlled conditions using an airway exchange catheter, preferably under direct visualization with a flexible fiberoptic bronchoscope. We report unanticipated difficulties with supraglottic airway exchange caused by a kinked King LTS-D laryngeal tube.
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Median arcuate ligament syndrome (MALS), also known as celiac artery compression syndrome, is an uncommon condition classically characterized by chronic abdominal pain, weight loss, and abdominal bruit. Chronic mesenteric ischemia caused by intermittent compression of the celiac artery by the MAL provokes upper abdominal pain that is sympathetically mediated via the celiac plexus. Because it is a diagnosis of exclusion, diagnosis of MALS in the clinical setting is typically challenging. We present an atypical case which highlights the utility of celiac plexus block as both an assistant diagnostic tool and a predictor of surgical outcomes for suspected MALS.
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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
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.