A & A case reports
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Review Case Reports
Mechanical Support With Impella During Malignant Arrhythmia Ablation: A Case Report on the Growing Trend in the Electrophysiology Laboratory.
Congenitally corrected transposition of the great arteries is a rare form of congenital heart disease in which the persistence of the right ventricle as the systemic ventricle leads to heart failure, tricuspid valve insufficiency, and arrhythmia. Supraventricular arrhythmias are especially common in these patients. We discuss the anesthetic management of a 33-year-old patient with congenitally corrected transposition of the great arteries who required a ventricular assist device to maintain cardiac output during ablation of supraventricular tachyarrythmia. A witnessed pulseless cardiac arrest and resuscitation during a previous episode of supraventricular tachycardia prompted the elective insertion of the Impella catheter after induction of anesthesia for the ablation procedure.
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We report a case of successful intraoperative management using only low-volume regional anesthesia for the open surgical fixation of a traumatic clavicle fracture in a conscious 69-year-old man with severe chronic obstructive pulmonary disease. To avoid general anesthesia, we provided low-volume C5 and C6 nerve root blocks along with a superficial cervical plexus block using only 9 mL of anesthetic solution to avoid the often encountered complications of higher volume injections. Throughout the procedure, the patient remained comfortable and cooperative with stable hemodynamics and respiration. The postoperative course was uncomplicated.
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Case Reports
Continuous Erector Spinae Plane Block for Rescue Analgesia in Thoracotomy After Epidural Failure: A Case Report.
The ultrasound-guided erector spinae plane (ESP) block is a newly described technique for providing thoracic analgesia. It is simple to perform and relatively noninvasive compared with thoracic epidural analgesia. In addition, the anatomy lends itself well to catheter insertion for continuous blockade. In this report, we describe the use of the ESP block as a rescue analgesic technique for postthoracotomy analgesia in a patient with failed thoracic epidural analgesia.
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Case Reports
Complete Antethoracic Block for Analgesia After Modified Radical Mastectomy: A Case Report.
Complete antethoracic block for modified radical mastectomy is a composite block comprising the antethoracic medial, antethoracic inferior, and antethoracic lateral blocks. The puncture targets of all components are easy to identify, and the risk of complications such as pneumothorax is low. ⋯ After induction of general anesthesia, but before surgical incision, she received a complete antethoracic block for anesthesia, which also provided good analgesia postoperatively. We believe that complete antethoracic block is suitable for postoperative analgesia in patients undergoing this surgery.
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Review Case Reports
Case Report of a Patient With Idiopathic Hypersomnia and a Family History of Malignant Hyperthermia Undergoing General Anesthesia: An Overview of the Anesthetic Considerations.
The pathophysiologic underpinnings of idiopathic hypersomnia and its interactions with anesthetic medications remain poorly understood. There is a scarcity of literature describing this patient population in the surgical setting. This case report outlines the anesthetic considerations and management plan for a 55-year-old female patient with a known history of idiopathic hypersomnia undergoing an elective shoulder arthroscopy in the ambulatory setting. ⋯ Anesthesia was maintained with total intravenous anesthesia via the use of propofol and remifentanil. The depth of anesthesia was monitored with entropy. There were no perioperative complications.