AANA journal
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Procedural sedation in children and adolescents is becoming increasingly employed to facilitate successful diagnostic imaging studies. Keeping the patient adequately sedated yet easily arousable can be of utmost importance during image-guided diskography. Dexmedetomidine provides an adequate level of sedation for diagnostic imaging studies. ⋯ In addition, it preserves respiratory function even when administered in higher-than-recommended doses for sedation. This case series describes our clinical experience in using dexmedetomidine as the sole sedative agent to facilitate diskography in 4 adolescent patients, ranging in age from 15 to 18 years, who presented with chief complaints of back pain and degenerative diskitis. The clinical endpoints of sedation and analgesia were cooperative and still patients during needle placement in the intervertebral disks.
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Case Reports
Renal transplantation from an unrelated living donor to a malignant hyperthermia-susceptible patient: a case report.
A 56-year-old patient with renal insufficiency secondary to Alport syndrome presented for kidney transplantation from an unrelated living donor. The recipient had a medical history that included 2 episodes of malignant hyperthermia: in 1989 and 1991. On both occasions she was treated with dantrolene. ⋯ Both the kidney donor and the recipient underwent nontriggering general anesthetics using total intravenous anesthesia techniques without the use of prophylactic dantrolene. Using this technique, the MHS kidney recipient did not experience a malignant hyperthermia episode perioperatively. The donor and the recipient had uneventful clinical courses, and to date the renal transplantation has been successful.
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Case Reports
Intrathecal hydromorphone for cesarean delivery: in search of improved postoperative pain management: a case report.
Currently, morphine and fentanyl are the most commonly used intrathecal opioids for the postoperative pain management of patients who underwent cesarean delivery. Unfortunately, the analgesic benefits of these 2 drugs tend to fall into different extremes based on lipid solubility. Intrathecal hydromorphone may provide more consistent analgesia because its lipid solubility falls between that of the other 2 opioids. ⋯ Intrathecal hydromorphone was found to have provided superior pain relief with fewer side effects in this patient, who received intrathecal morphine for the same surgery 2 years earlier. This case report supports an emerging hypothesis that intrathecal hydromorphone is not only safe but possibly more effective than other intrathecal opioids for pain management after cesarean delivery. The purpose of this case report is to encourage the development of more research regarding this use of intrathecal hydromorphone.