Curēus
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Background A neuromuscular blockade (NMB) is used in general anesthesia to facilitate endotracheal intubation and muscle relaxation during procedural and surgical interventions. Rapid and complete reversal of the NMB allows for patient recovery to the preoperative baseline with ventilation and motor function, along with the complete return of gastroesophageal motility, thereby expediting recovery and preventing microaspiration in the postoperative period. Sugammadex is a modified gamma cyclodextrin that complexes with steroidal neuromuscular blocking agents (specifically, rocuronium and vecuronium), leading to a molecular gradient and removal of the agents from the neuromuscular junction. ⋯ Comparison of reversal with sugammadex versus neostigmine, plus glycopyrrolate, and time spent in the post-anesthesia care unit was 83.6 (48.6) minutes versus 81.7 (46.6) (p = 0.73), respectively. Conclusions In this retrospective cohort study, we observed a deviation in the recommended sugammadex dosage and increased reintubation rates but no difference in time to extubation or Post-Anesthesia Care Unit (PACU) length of stay times when patients received sugammadex compared to neostigmine, plus glycopyrrolate, for neuromuscular blockade reversal. Understanding the PACU flow and culture, education of providers about dosages, along with completion of prospective studies, to correlate acceleromyograph values to reversal and postoperative ventilatory and deglutary function can help assess the true clinical value of sugammadex.
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Case Reports
Shark Fin Electrocardiogram: A Deadly Electrocardiogram Pattern in ST-Elevation Myocardial Infarction (STEMI).
Shark fin electrocardiographic (ECG) pattern, also known as 'Lambda-wave', 'giant R waves', or 'triangular QRS-ST-T waveform' is a dangerous ECG pattern associated with ST-elevation myocardial infarction (STEMI). It is formed by the fusion of QRS, ST, and T waves and predicts the high risk of mortality due to cardiogenic shock and ventricular fibrillation. ⋯ Thus, differentiating it from other conditions causing similar ECG changes and prompt management is highly important to save the patient from serious complications. Here we have presented a case of STEMI with shark fin ECG associated with pulmonary edema (Killip class III acute myocardial infarction).
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Background The combination of a thoracic paravertebral block (TPVB) and erector spinae plane block (ESPB) has not been investigated. We aimed to evaluate the effects of the combination of TPVB and ESPB particularly on postoperative pain scores in patients undergoing video-assisted thoracic surgery (VATS). Methods From January 1, 2021, to March 1, 2021, 13 patients older than 18 years who underwent combined ESPB and TPVB for analgesic treatment after elective VATS were included in the study. ⋯ Nausea and vomiting were observed in only one case in the early postoperative period. Conclusıons As a new technique, the combination of TPVB and ESPB in this preliminary study provided effective postoperative pain management along with the use of morphine in acceptable quantities. Large-scale, randomized-controlled, and comparative studies are needed to demonstrate the efficacy of the combination of TPVB and ESPB.
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Case Reports
The Young Heart Tears Easily Apart: A Case Report of Spontaneous Coronary Artery Dissection.
Spontaneous coronary artery dissection (SCAD) is a rare cause of acute coronary syndrome (ACS), seen mostly in young females. The rarity and limited knowledge of the disease make its management challenging. Prompt diagnosis of the condition is extremely important to decrease both long- and short-term complications. ⋯ These two cases highlight the importance of keeping in mind the possibility of SCAD, especially when relatively healthy young women present with anginal symptoms. Early diagnosis of the condition and prompt management are extremely important to ensure favourable outcomes. The two cases also describe the coronary angiogram findings in SCAD, and the different strategies employed in the management of this condition.
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Objectives While penicillin allergies are commonly reported, their cross-reactivity with beta-lactam antibiotics is minimal. First-line treatment of gonorrheal infections includes a cephalosporin. In emergency department (ED) environments, physicians must consider these potential allergies when selecting antibiotics for a patient with symptoms concerning for sexually transmitted infection (STI). ⋯ Conclusions Patients with penicillin allergies represent a recurring challenge for ED physicians when faced with antibiotic selection for STI symptoms concerning for gonorrheal infection. Those with penicillin allergies are significantly less likely to receive a cephalosporin antibiotic, though these remain the only universally accepted treatment for gonorrheal infections. These findings highlight the significant need for further physician and public education on allergies and antibiotic selection.