A&A Practice

Clark, Brittney M.; Pagani-Estevez, Gabriel L.; Johnson, Rebecca L.

doi: 10.1213/XAA.0000000000000772pmid: 29672324

Intraoperative tourniquet-related pain is well recognized by anesthesiologists, but postoperative tourniquet-related pain has received little attention. We present a patient who underwent a total knee arthroplasty under general anesthesia and an adductor canal nerve block. She complained of intractable thigh pain postoperatively. Lidocaine 5% patches completely resolved her postoperative tourniquet-related pain.

Yamada, Takashige; Suzuki, Takeshi; Murase, Reiko; Nagata, Hiromasa; Kosugi, Shizuko

doi: 10.1213/XAA.0000000000000774pmid: 29672323

We describe 2 patients who developed anaphylactic shock after sugammadex administration during anesthesia. Both had no history of prior sugammadex administration. The serum tryptase concentrations were elevated after the allergic reaction. Basophil activation testing 1 month after the events was positive for sugammadex in 1 patient, and negative in the other. However, it was positive for light-exposed sugammadex solution in both patients, suggesting a possible allergic reaction to a denatured compound of sugammadex generated by light exposure of the sugammadex solution.

Abe, Sayumi; Osaka, Yoshimune; Morita, Yoshihisa

doi: 10.1213/XAA.0000000000000776pmid: 29688926

Knotting of a nasogastric (NG) tube around a left nasotracheal tube occurred in the pharynx during its blind insertion via the right nares. Unusual resistance was encountered during its advancement and attempted withdrawal. The nasotracheal tube moved in tandem with the NG tube. The NG tube was cut and the lower portion removed via the mouth and the upper portion removed via the right nares.

Kimachi, Pedro Paulo; Martins, Elaine Gomes; Peng, Philip; Forero, Mauricio

doi: 10.1213/XAA.0000000000000777pmid: 29688930

We described the first ultrasound-guided erector spinae plane block that provided complete surgical anesthesia for a right-sided mastectomy and axillary dissection in a patient with high cardiovascular risk. The block targeted at T5, and 20 mL of 0.5% ropivacaine with epinephrine 1:200,000 and dexamethasone 8 mg was administered. Complete anesthesia was accomplished in 20 minutes, and the patient received propofol infusion for sedation. The patient reported no pain and remained hemodynamically stable throughout the 2.5-hour procedure. At the end of the surgery, patient received morphine 2 mg and dipyrone 2 g intravenously, and demanded no analgesic until 24 hours after the procedure.

Sekhri, Nitin K.; Parikh, Shalvi; Foo, R. Marcus

doi: 10.1213/XAA.0000000000000869pmid: 30199401

The authors present a report of a pulsed radiofrequency ablation of the stellate ganglion performed on a patient with microemboli to the hand from a thrombosed abandoned arteriovenous fistula. The patient was initially managed using vasodilators and anticoagulation. However, the patient’s skin mottling, pain, and decreased strength persisted. Ablation of the stellate ganglia increased perfusion to his hand and likely prevented amputation that has lasted for approximately 1 year. While radiofrequency ablation is more commonly used for pain syndromes, this is an example of its use in the treatment and potential treatment of acute ischemia.

Tanaka, Pedro; Adriano, Aileen; Ngai, Lynn; Park, Yoon Soo; Marty, Adrian; Wakatsuki, Shin; Brun, Carlos; Harrison, Kyle; Bushell, Erin; Thomsen, Jakob Louis Demant; Wen, Louise; Painter, Christopher; Chen, Marianne; Macario, Alex

Bandyopadhyay, Saikat; Mandana, Kayapanda

doi: 10.1213/XAA.0000000000000783pmid: 29688928

Supplemental Digital Content is available in the text.

Luzzi, Carla Andrea; Rao, Vivek; Meineri, Massimiliano

doi: 10.1213/XAA.0000000000000789pmid: 29738331

Supplemental Digital Content is available in the text.