A & A case reports
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Comparative Study
In the United States, "Opt-Out" States Show No Increase in Access to Anesthesia Services for Medicare Beneficiaries Compared with Non-"Opt-Out" States.
In the United States, anesthesia care can be provided by anesthesiologists or nurse anesthetists. Since 2001, 17 states have exercised their right to "opt-out" of the federal requirement that a physician supervise the administration of anesthesia by a nurse anesthetist, with the majority citing increased access to anesthesia care as the rationale for their decision. By using Medicare data, we found that most (4 of 5) cohorts of "opt-out" states likely experienced smaller growth in anesthesia utilization rates compared with non-"opt-out" states, suggesting that opt-out was not associated with an increase in access to anesthesia care.
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Complex regional pain syndrome (CRPS) is evoked by conditions that may be associated with local and/or systemic inflammation. We present a case of long-standing CRPS in a patient with Ehlers-Danlos syndrome in which prolonged remission was attained by directing therapy toward concomitant small intestinal bacterial overgrowth, obstructive sleep apnea, and potential increased microglia activity. We theorize that cytokine production produced by small intestinal bacterial overgrowth and obstructive sleep apnea may act as stimuli for ongoing CRPS symptoms. CRPS may also benefit from the properties of low-dose naltrexone that blocks microglia Toll-like receptors and induces production of endorphins that regulate and reduce inflammation.
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In the pediatric population, development of an abscess after epidural analgesia is a rare event. We report who is believed to be the youngest patient with development of an epidural abscess secondary to epidural catheter placement. We detail the infant's symptoms, radiographic workup, surgical treatment, and follow-up.
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Thoracic anesthesia procedures are challenging to master during anesthesia training. A Laerdal ALS Simulator® manikin was modified by adding a bronchial tree module to create fidelity to the fourth generation. ⋯ Insertion of left and right 35-Fr double-lumen tubes permits double- and single-lung ventilation with continuous positive airway pressure and positive end-expiratory pressure. This anatomical modification created a high-fidelity training tool for thoracic anesthesia that has been incorporated into educational curricula for anesthesia.
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A 56-year-old man receiving mechanical circulatory support via a biventricular assist device suffered an airway emergency secondary to bleeding into the airway. An improvised solution to gain control of the airway in the short term was devised, and an oxygenator was inserted into the circuit, providing an alternative means of gas exchange while definitive control of the airway was achieved. This case changed practice in our institution, where we now make contingency plans for emergency oxygenator insertion into the circuits of all patients with a biventricular assist device who show any sign of airway hemorrhage.