Journal of clinical anesthesia
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Comparative Study
The use of ultrasound in planned cesarean delivery under spinal anesthesia for patients having nonprominent anatomic landmarks.
The aim of the study was to compare conventional landmark method with ultrasound-guided spinal anesthesia in cesarean delivery cases where spinous processes and interspinous spaces were not prominent on physical examination. ⋯ Ultrasound guidance is an effective and safe method to reduce the number of puncture attempts, improve the success rate of subarachnoid access on the first attempt, and reduce the need to puncture multiple levels, although it prolongs procedure time in patients with score 2 according to our scoring system designed for this current study.
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Patients with isolated peripheral branch neuralgia of trigeminal nerve usually receive traditional treatment such as medical therapy and interventional procedures targeting the entire trigeminal nerve or related ganglions. However, if the intractable pain is limited to a certain branch, the patient may also benefit from a peripheral and nerve-targeted interventional approach. Here, we report the management of a patient with isolated infraorbital neuralgia by ultrasound-guided infraorbital nerve block with steroid and local anesthetic combination. 48years-old male patient diagnosed with trigeminal neuralgia was resistant to medical therapy for 3years. ⋯ Following a diagnostic ultrasound-guided infraorbital nerve block with 1% lidocaine, the block was repeated twice with 15mg lidocaine and 1.5mg dexamethasone in a total volume of 1.5mL in a month. The patient's NRS and LANSS scores decreased to 2 and 8, for approximately 21months until this report was written. We suggest that ultrasound-guided infraorbital nerve block with dexamethasone and lidocaine combination may present as an initial interventional treatment option in patients with isolated infraorbital neuralgia.
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Case Reports
Use of Sugammadex in an octagenerian with Myaesthenia Gravis undergoing emergency laporotomy.
Myaesthenia Gravis is an autoimmune disorder that results in increased sensitivity to neuromuscular blockers. Anaesthesia and surgery in patients with Myaesthenia Gravis is associated with an increased incidence of complications, including post operative ventilation. We report the successful use of intra-operative train of four ratio monitoring and Sugammadex to reverse rocuronium induced neuromuscular blockade in an elderly octagenarian with Myaesthenia Gravis undergoing an emergency laporotomy. ⋯ We report the successful use of intra-operative neuromuscular monitoring and Sugammadex to reverse rocuronium induced neuromuscular blockade in an elderly octagenarian with Myaesthenia Gravis undergoing emergency laporotomy.
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Obese parturients both greatly benefit from neuraxial techniques, and may represent a technical challenge to obstetric anesthesiologists. Several studies address the topic of obesity and neuraxial analgesia in general, but few offer well described definitions or rates of "difficulty" and "failure" of labor epidural analgesia. Providing those definitions, we hypothesized that increasing body mass index (BMI) is associated with negative outcomes in both categories and increased time needed for epidural placement. ⋯ Obesity is associated with increasing technical difficulty and failure of neuraxial analgesia for labor. Practitioners should consider allotting extra time for obese parturients in order to manage potential problems.
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Case Reports
Monitoring of the intraoperative analgesia by pupillometry during laparoscopic splenectomy for splenic hydatid cyst.
Echinococcosis causes a hydatid cyst, a worldwide disease. Human beings are intermediate hosts, but dogs complete the life cycle of the cestode. The most common presentation sites are the liver and lungs. ⋯ This is regulated by the autonomous sympathetic system. It appears to be more sensitive and reliable than using simple variations in heart rate and blood pressure. It is an easy and safe to use method that might allow a reduction in postoperative analgesic requirements.