Journal of clinical anesthesia
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To show that a complex motor skill can be taught without requiring active expert faculty participation. ⋯ Teaching a complex motor skill with no expert instruction is possible.
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A 61-year-old patient with severe stump pain required hospitalization and intravenous opioids for pain control. After evaluation by our anesthesia pain management service, we concluded that the patient had a neuroma at the site of sciatic nerve transection and that injection of a mixture of local anesthetic and corticosteroid at the site of the neuroma was the most appropriate management. Because the alternative methods of nerve localization (eg, motor stimulation, paresthesia) were unlikely to be successful, we felt that the most reliable way to accomplish this task was to use live ultrasound guidance. After a series of 4 ultrasound-guided blocks with bupivacaine and methylprednisolone acetate, the patient's pain was alleviated to the point at which it was managed with occasional doses of oral opioids.
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A patient who sustained a posterior shoulder subluxation injury after being positioned in the lateral decubitus head-down position during emergence from general anesthesia is presented. It is postulated that the injury occurred as a result of violent retching while in the lateral position.
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Letter Case Reports
Pentax-AWS (Airway Scope) for awake tracheal intubation.