A & A case reports
-
Case Reports
Ultrasound-guided continuous quadratus lumborum block for postoperative analgesia in a pediatric patient.
Quadratus lumborum block is a recently introduced variation of transversus abdominis plane block. In this report, we describe the use of ultrasound-guided continuous quadratus lumborum block for postoperative analgesia in a 7-year-old child scheduled to undergo radical nephrectomy (left-sided) for Wilms tumor. The result was excellent postoperative analgesia and minimal requirement for rescue analgesics. The modification described may allow easier placement of a catheter for continuous infusion of local anesthetic.
-
Case Reports
Thoracic paravertebral catheter placement for acute rib pain in a pregnant patient with cystic fibrosis.
A 30-year-old woman with cystic fibrosis at 33 weeks, 4 days' gestation sustained a rib injury during an acute pulmonary exacerbation, resulting in noncompliance with her chest wall oscillation therapy and worsening of her respiratory status with concern for inducing labor early. Insertion of an ultrasound-guided thoracic paravertebral catheter produced immediate pain relief, eliminating the need for further opioids, and she was able to tolerate her chest wall oscillation treatment. She was discharged home after 7 days and was able to deliver a healthy baby at 38 weeks via spontaneous vaginal delivery.
-
Case Reports Observational Study
Acute cellular insulin resistance and hyperglycemia associated with hypophosphatemia after cardiac surgery.
Successful glycemic control reduces morbidity and mortality in cardiac surgery patients. Protocols that include insulin infusions are commonly followed to achieve target blood glucose levels. ⋯ The following case series is a retrospective observational review of 8 cardiac surgery patients who developed insulin resistance early after surgery; this resistance was reversed by correcting serum hypophosphatemia. We discuss the multiple underlying mechanisms causing hypophosphatemia.
-
Harlequin ichthyosis (HI) is a rare disorder of defective lipid transport resulting in severe epidermal hyperkeratosis producing large plate-like scales. Although mortality is high, improved treatments have allowed some with HI to survive into their third and fourth decades. However, until this case, there have been no known reports of pregnancy followed by birth of a healthy neonate to a mother with HI. We report one of the only approximately 25 known current HI survivors worldwide unique in having carried a pregnancy to full term and outline challenges for the anesthesiologist during labor and delivery.