A&A practice
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Case Reports
Retrolaminar Continuous Nerve Block Catheter for Multiple Rib Fractures: A Case Report.
Rib fractures carry high morbidity and mortality due to pain-related complications, such as hypoventilation, atelectasis, and pneumonia. Ultrasound-guided regional anesthesia is a common treatment for pain associated with rib fractures. ⋯ In these instances, it is advantageous to have a tactile or landmark-based approach to treating rib fracture pain. We present a case of a continuous retrolaminar nerve block catheter placed without ultrasound guidance in a 67-year-old man with oxygen-dependent chronic obstructive pulmonary disease and a prior intrathecal pump, who presents with multiple unilateral rib fractures.
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High-frequency jet ventilation (HFJV) can reduce organ movement that otherwise complicates percutaneous image-guided ablation (IGA) procedures. This study describes feasibility and safety of the technique in routine use. ⋯ We describe the characteristics of patients, procedures, and adverse events. It is feasible to use HFJV as the routine standard of care for IGA.
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Features of Noonan syndrome include a distinctive facial appearance, short stature, a broad or webbed neck, congenital heart disease, bleeding problems, skeletal malformations, and developmental delay. Although pulmonary stenosis is most commonly reported, up to 20% of patients have hypertrophic cardiomyopathy (HCM). We report the use of a combined spinal-caudal epidural anesthesia technique during urologic surgery (pyeloplasty) in an 8-week-old infant with Noonan syndrome and HCM. A spinal-caudal epidural technique provides favorable hemodynamic conditions, avoids the need for airway instrumentation, and may serve as an alternative to general anesthesia in these high risk patients.
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The use of intraoperative transesophageal echocardiography (TEE) to assess venous congestion of the liver due to right heart dysfunction is well established, predominately through the Doppler interrogation of the hepatic and portal venous waveforms. Transjugular intrahepatic portosystemic shunts (TIPSs) are artificial intraparenchymal tracts through the liver that are placed to decompress the portal circulation in the setting of portal hypertension, most commonly due to cirrhosis. Herein, we describe the Doppler interrogation of a TIPS using intraoperative TEE, and how changes in the transmitted portal venous waveform were used to assess the severity of tricuspid regurgitation and inform management. (A&A Practice. 2022;16:e01607.).
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With aging-associated obesity and osteoarthritis, anesthesiology trainees and their instructors face difficulties in identifying the surface anatomy and landmarks for spinal anesthesia, and successfully advancing the needle into the intrathecal space. Through a series of illustrations and instructions, this teaching tool suggests that using a spinal needle in the same way that a blind person uses a white cane may improve a trainee's ability to successfully perform a lumbar puncture. Reviewing the technique and instructions with the trainee before approaching the patient can minimize verbal instructions in the patient's presence and may lead to improved efficiency and trainee success.