A & A case reports
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Case Reports
Successful Continuous Adductor Canal Block Placement in a Patient With Absent Sartorius Muscle: A Case Report.
We report a novel case of a patient who presented for elective total knee arthroplasty and had distorted adductor canal anatomy due to previous sartorius rotational flap surgery. Despite the lack of a sartorius muscle on the intended operative limb, we describe the successful placement of a continuous adductor canal block. This case is a clinically relevant example that highlights the importance of the vastoadductor membrane as the anatomical anteromedial boundary for the adductor canal, and that it remains intact even after sartorius muscle flap surgery.
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Case Reports
Intraoperative Hyperkalemia and Ventricular Arrhythmia During Parathyroidectomy: A Case Report.
We present a case of acute hyperkalemia and ventricular arrhythmia during parathyroidectomy in a patient with end-stage renal disease. This case highlights the under-recognized alterations in potassium homeostasis associated with parathyroidectomy and underscores the importance of preoperative optimization.
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Case Reports
Temporary Decompression of Symptomatic Epidural Hematoma via an In Situ Epidural Catheter: A Case Report.
Spinal epidural hematoma (SEH) following neuraxial anesthesia needs prompt recognition and early decompressive measures to prevent long-term neurologic injury. We report a case of SEH presenting on the second postoperative day during an ongoing epidural infusion. ⋯ We describe the timeline of the presentation of SEH and the subsequent clinical course in our patient. Aspiration of blood through an in situ epidural catheter may not only point toward the possibility of SEH but may also temporarily decompress the spinal canal.
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Case Reports
Unique Considerations in Spinal Cord Stimulator Placement in Pediatrics: A Case Report.
Spinal cord stimulation can be a valuable treatment option in the management of neuropathic pain in select pediatric patients. We present a unique case of a 16-year-old girl with Klippel-Trenaunay-Weber syndrome and scoliosis who required the placement of a spinal cord stimulator (SCS) for severe sciatic nerve neuropathic pain after a right above-knee amputation. Several attempts at lead placement were required before successful pain coverage was achieved because of late recognition of significant vertebral body rotation. This case highlights important considerations in pediatric SCS placement including a careful review of the spinal cord anatomy before the placement of an SCS.
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Case Reports
Dexmedetomidine as a Supplement to Spinal Anesthesia Block: A Case Report of Three Infants.
We report a novel use for dexmedetomidine as a supplemental intravenous or intranasal sedative for spinal anesthesia in infants. The children were 1, 2, and 9 months old having either inguinal hernia repair or circumcision. None of them experienced clinically relevant hemodynamic changes or apnea. Pain scores were zero throughout the postoperative period.