Journal of clinical anesthesia
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The study objective is to evaluate a scoring system to assess the quality of anesthesia used in ophthalmic surgery. ⋯ The quality of ophthalmic anesthesia is an important component of the surgical procedure and should be considered in any risk stratification. Suboptimal anesthesia is associated with an increased rate of surgical complications.
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Case Reports
Systemic ropivacaine toxicity from a peripheral nerve infusion in a medically complex patient.
This is a case of systemic ropivacaine toxicity from a sciatic nerve catheter. A 20-year-old patient after heart transplant with poor systemic perfusion on hemodialysis and multiple medications experienced local anesthetic systemic toxicity 72 hours after placement of a peripheral nerve catheter. The case demonstrates the potentially significant impact of medical comorbidities on system absorption of local anesthetics and reinforces that existing dose guidelines are not evidence based, and literature to guide local anesthetic bolus supplementation of continuous infusions is scant.
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Case Reports
Endocarditic sinus of valsalva fistulae to right ventricular outflow tract in adult ventricular septal defects.
Surgical repair of congenital ventricular septal defects (VSDs) in adults is quite rare. Most congenital VSDs are repaired in children. Of those adult patients diagnosed as having VSDs, many are not repaired due to irreversible pulmonary vascular disease. ⋯ This patient refused surgery until the progressive dyspnea was worsened by the endocarditis and the fistulas. At the time of surgery, his ventricular ejection fraction measured 47%, the ventricular chambers were enlarged, and the pulmonary to systemic flow ratio measured 2:1. He did well clinically after the VSD and fistulae repair.