A&A practice
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Ear pain is mediated by cranial nerves V, IX, and X, as well as branches of C2 and C3, including the occipital nerve. Occipital neuralgia may play a role in the development or worsening of tinnitus and otalgia. The authors reviewed and report 33 cases of ultrasound-guided occipital nerve blocks in patients with tinnitus and otalgia, with postprocedure follow-up intervals of up to 2 years. We found that greater occipital nerve blocks may be a valuable treatment method for these patients.
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We present a 67-year-old woman who was hemodynamically stable with radiographic evidence of saddle pulmonary embolism (PE) in the main pulmonary artery and mobile thrombus in the right heart. Endovascular thrombectomy was scheduled under general anesthesia. Before anesthesia induction, femoral vessel access was planned under local anesthesia in case emergent cardiopulmonary bypass (CPB) was needed. ⋯ Transesophageal echocardiography (TEE) confirmed acute massive PE. CPB was emergently established. Surgical embolectomy was conducted with successful outcome.
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Pulmonary aspiration continues to be a major cause of anesthesia-related mortality. Anesthesiologists are encouraged to perform bronchoscopy to manage aspiration of particulate matter; however, they have limited training and experience in clearing luminal obstructions endoscopically. ⋯ However, bronchoscopy by the gastroenterologist using a pediatric gastroscope cleared the bronchi of debris and led to immediate clinical improvement. Anesthesiologists, faced with particulate matter aspiration, could consider assistance from a gastrointestinal endoscopist.
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Case Reports
Anesthetic Management of a Patient With an Implantable Hypoglossal Nerve Stimulator: A Case Report.
Obstructive sleep apnea (OSA) is a common condition, particularly in obese men and in those with an increased neck circumference. Management with a continuous positive airway pressure (CPAP) machine has been the mainstay of treatment over many years; although, it is not acceptable to all. Recently, innovative medical devices, such as hypoglossal nerve stimulators, have emerged and are now being increasingly utilized. We present a case report of a patient undergoing rotator cuff repair on the same side as the implanted device and our recommendations on the anesthetic management.
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Acute pulmonary embolism is a serious perioperative complication. Current guidelines focus on hemodynamic stabilization and rapid restoration of pulmonary artery blood flow. ⋯ We report a case of acute pulmonary embolism with cardiopulmonary arrest during orthopedic surgery. Prompt thrombolysis and gaining control of both thrombolytic therapy-induced bleeding from the wound and a hepatic cyst enabled the patient to recover without neurological deficits.