Effects of Adding Intrathecal Epinephrine to Spinal Anesthesia on Anesthesia-Related Cesarean Delivery Outcomes: Should We Reconsider Its Use?

Background:  Intrathecal epinephrine is used to increase the duration of spinal anesthesia for amenable surgical procedures anticipated to require additional time; however, in the ambulatory setting, it is associated with a prolonged time to post-anesthesia care unit (PACU) discharge. The current study's authors hypothesized that adding intrathecal epinephrine to spinal anesthesia for cesarean delivery would be associated with a dose-dependent prolonged post-anesthesia unit length of stay.

Methods: A single-center, retrospective study of patients undergoing repeat cesarean delivery under spinal anesthesia from 2011 to 2015 was conducted.

Clonidine as an Adjunct for the Successful Treatment of Labor Epidural Infusion-Associated Interscapular Pain.

Epidural infusion-associated interscapular pain for laboring parturients is a treatment dilemma for obstetric anesthesiologists. We report a case of a parturient who was successfully treated for labor epidural analgesia-associated interscapular pain. Our treatment plan included reducing the volume of local anesthetic administered by adding the adjunct of clonidine, increasing the epidural solution concentration of local anesthetic, and reducing the overall infusion rate.

Proximal Ultrasound-Guided Posterior Tibial Nerve Block for the Removal of Calcaneal Hardware.

The anesthetic technique for calcaneal surgery has been reported to include peripheral nerve blocks, such as a sciatic block in the popliteal fossa, followed by intraoperative sedation. Sciatic nerve blocks are associated with limb weakness and fall risk. We present a case of a patient presenting for outpatient calcaneal surgery.

Verticalization Therapy for Acute Respiratory Distress Syndrome Patients Receiving Veno-Venous Extracorporeal Membrane Oxygenation.

Persistent hypoxemia during veno-venous extracorporeal membrane oxygenation (VV-ECMO) for supporting acute respiratory distress syndrome (ARDS) patients is a clinical challenge for intensive care medical providers. Prone positioning is an effective strategy to treat persistent hypoxemia; however, placing a patient in a prone position is resource intensive with significant risks to the patient. We present a patient with severe ARDS receiving VV-ECMO who underwent verticalization therapy and subsequently recovered pulmonary function.

Vasovagal Syncope and Transient Asystole During Peripheral Nerve Blockade.

Vasovagal syncope has been associated with chronic pain procedures, phlebotomy, and musculoskeletal injections. While vasovagal syncope is commonly associated with interventional pain procedures, its occurrence during peripheral nerve block procedures has not been reported. We report a case of vasovagal syncope leading to transient asystole in a patient undergoing a lower extremity peripheral nerve block procedure.

Inappropriate Implantable Cardioverter-Defibrillator Therapy During Total Hip Arthroplasty.

Electromagnetic interference (EMI) is a known risk factor for triggering inappropriate therapy from implantable cardioverter-defibrillators (ICDs). Recommendations from the American Society of Anesthesiologists focus on EMI when using monopolar electrocautery for supraumbilical surgeries. Infraumbilical surgeries are not considered high risk for EMI; thus, no magnet must be applied routinely to prevent inappropriate ICD therapy intraoperatively.

Spontaneous Retroperitoneal Hematoma After Total Hip Arthroplasty.

Spontaneous retroperitoneal hematomas are a rare yet potentially devastating occurrence associated with antiplatelet and anticoagulant therapies. We present a case of a spontaneous retroperitoneal hematoma post-operatively after a total hip arthroplasty surgery performed under a midline approach spinal anesthetic. A 79-year-old male with a BMI of 25.

Two Cases of Intraoperative ECG Artifact Mimicking Ventricular Tachycardia and How to Know When It Is Real.

Electrocardiographic (ECG) artifacts may resemble ventricular tachycardia (VT), leading to inappropriate therapies. Despite extensive training, electrophysiologists have still been shown to misinterpret artifacts. The literature is scant regarding the intraoperative identification by anesthesia providers of ECG artifacts resembling VT.

The Successful Anesthetic Management of a Cesarean Delivery in a Patient with Fanconi-Bickel Syndrome.

Introduction: Fanconi-Bickel syndrome (FBS) is a rare genetic condition characterized by extremely short stature, renal tubular dysfunction, osteoporosis, and rickets. The literature is scant regarding the successful reproduction of women with FBS. Cesarean delivery is indicated due to the risk of pelvic fracture from vaginal delivery in a patient with FBS and rickets, yet no case describing the anesthetic has been reported.

When Left Is Right and Right Is Wrong: A Case Report of Two Near-Miss Wrong-Sided Peripheral Nerve Blocks.

Wrong-sided peripheral nerve blocks occur with a surprisingly high frequency despite being described as a "never event." Timeout procedures are performed and documented, yet timeout omission is rarely cited as a contributing factor for wrong-sided blocks. We present two cases of near-miss wrong-sided peripheral nerve blocks and provide recommendations based on the current literature and the most common contributing factors.

The incidence of coagulopathy in pregnant patients with intrahepatic cholestasis: should we delay or avoid neuraxial analgesia?

Study Objective: To estimate the incidence of coagulopathy in patients with intrahepatic cholestasis inhepatic cholestasis of pregnancy (ICP).

Design: Retrospective cohort investigation.

Setting: University medical center.

Nerve stimulator-guided supplemental popliteal sciatic nerve block after a failed sciatic block does not increase the incidence of transient postoperative neurologic sequelae.

Background: Supplemental peripheral nerve blocks are not commonly performed in adults because of concerns of cumulative exposure of the nerve to the local anesthetic as well as increased ischemia from epinephrine. The purpose of this study was to compare the incidence of postoperative neurologic symptoms after a failed subgluteal sciatic nerve block and a supplemental popliteal sciatic nerve block.

Methods: Five hundred twelve adult patients undergoing ambulatory surgery were prospectively studied (1 yr).

A case report of reappearance of spinal anesthesia.

Objective: We present a case of reappearance of spinal anesthesia despite the use of plain (isobaric) lidocaine and without an associated cough or Valsalva maneuver.

Case Report: A 66-year-old man had spinal anesthesia for knee arthroscopy. Two hours after the induction of spinal anesthesia and after the patient's motor strength had returned to the lower extremities, his head was elevated to 30 degrees.