Acta anaesthesiologica Scandinavica
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Acta Anaesthesiol Scand · Nov 2014
Case ReportsPeri-operative massive pulmonary embolism management: is veno-arterial ECMO a therapeutic option?
Pulmonary embolism remains an important clinical problem with a high mortality rate. The potential for sudden and fatal hemodynamic deterioration highlights the need for a prompt diagnosis and appropriate intervention. The purpose of the present case report is to describe a successful peri-operative veno-arterial extra corporeal membrane oxygenation (VA-ECMO) implantation for assumed massive pulmonary embolism associated with high hemodynamic instability and severe hypoxemia. ⋯ The patient was able to be mobilized 2 days after the surgery and was transferred to a rehabilitation ward on day 15. At that time, her cognitive functions had fully recovered. ECMO can provide lifesaving hemodynamic and respiratory support in patients with massive pulmonary embolism who are too unstable to tolerate other interventions, who have failed other therapies or for whom other therapies are contraindicated.
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Acta Anaesthesiol Scand · Nov 2014
Case ReportsMeralgia paresthetica-like symptoms following epidural analgesia after total knee arthroplasty.
Meralgia paresthetica (MP) is generally caused by entrapment of the lateral femoral cutaneous nerve (LFCN), and presents with pain and paresthesia in the anterolateral thigh. This paper describes a patient who had MP-like symptoms as a result of continuous epidural analgesia after total knee arthroplasty. The patient with pre-existing left foraminal stenosis at L3-L4 and disc herniations at L4-5 did not complain of paresthesia or pain during the combined spinal-epidural anesthetic procedure. ⋯ Although an ultrasound-guided diagnostic block of the LFCN was performed twice post-operatively, the patient's symptoms persisted. The symptoms gradually resolved 12 months after the surgery. In our case, we suggest that the continuous epidural infusate caused neural ischemia of the L3 nerve root by a compressive effect.
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Acta Anaesthesiol Scand · Nov 2014
Ultrasound-guided block of the suprascapular nerve - a volunteer study of a new proximal approach.
The standard approach for the suprascapular nerve block is deep in the supraspinous fossa. However, with this approach, the suprascapular nerve is difficult to visualize by ultrasound. The aim of this study was to describe a new method to visualize and selectively block the suprascapular nerve in a more superficial and proximal location. ⋯ We describe a new ultrasound-guided low-volume local anaesthetic technique to selectively block the suprascapular nerve. The potential clinical role of this new approach remains to be determined.
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Acta Anaesthesiol Scand · Nov 2014
Randomized Controlled TrialAdductor canal blockade for moderate to severe pain after arthroscopic knee surgery: a randomized controlled trial.
The analgesic effect of the adductor canal block (ACB) after knee surgery has been evaluated in a number of trials. We hypothesized that the ACB would provide substantial pain relief to patients responding with moderate to severe pain after arthroscopic knee surgery. ⋯ The ACB is a relevant option for patients with moderate to severe pain after arthroscopic knee surgery.