Anomalous Course of the Brachial Plexus Identified During Ultrasound-Guided Brachial Plexus Nerve Block.

Knowledge of brachial plexus anatomy is essential when performing upper-extremity regional anaesthesia. Anomalous brachial plexus anatomy has been reported in up to 35% of patients. Variants include anomalous course of the roots anterior to, or within, the scalene musculature and abnormal separation of the cords around the subclavian artery.

Regional anesthesia in patients with Charcot-Marie-Tooth disease: a historical cohort study of 53 patients.

Purpose: Anesthetic management for patients with Charcot-Marie-Tooth disease (CMT) is controversial. Description of the use of regional anesthesia (RA) in patients with CMT is limited. Regional anesthesia has traditionally been avoided because of risk of nerve injury.

Oxygen delivery failure due to improper installation of carbon dioxide absorbent canister: a case report.

The CLIC system in the Dräger Apollo anesthesia workstation allows a successful pre-use machine checkout without the presence of a carbon dioxide absorbent canister. It also allows the canister to be changed without interrupting controlled ventilation. However, this canister can be easily installed improperly with the CLIC adapter.

Paravertebral block for radiologically inserted gastrostomy tube placement in amyotrophic lateral sclerosis.

Introduction: Radiologically inserted gastrostomy (RIG) placement in patients with amyotrophic lateral sclerosis (ALS) carries risks related to periprocedural sedation and analgesia. To minimize these risks, we used a paravertebral block (PVB) technique for RIG placement.

Methods: We retrospectively reviewed patients with ALS undergoing RIG placement under PVB between 2013 and 2017.

Gastric emptying of "clear liquid drinks" assessed with gastric ultrasonography: a blinded, randomized pilot study.

Background: Protein-containing liquids may delay gastric emptying and increase risk of aspiration. Commercial whey protein nutritional drinks (WPNDs) are advertised as "clear liquid nutritional drinks" and can be mistaken for protein-free, carbohydrate-based clear liquids. We used gastric ultrasonography to compare gastric emptying of a protein-free, carbohydrate-based clear liquid with that of a WPND in healthy volunteers.

Tranexamic Acid Administration Is Not Associated With an Increase in Complications in High-Risk Patients Undergoing Primary Total Knee or Total Hip Arthroplasty: A Retrospective Case-Control Study of 38,220 Patients.

Background: Tranexamic acid (TXA) administration to reduce postoperative blood loss and transfusion is a well-established practice for total knee arthroplasty (TKA) and total hip arthroplasty (THA). However, clinical concerns remain about the safety of TXA in patients with a history of a prothrombotic condition. We sought to determine the risk of complications between high-risk and low-risk TKA and THA patients receiving TXA.

Peripheral Nerve Blocks and Immediate Postoperative Recovery: A Single-Institution Survey of Perianesthesia Nurses' Preferences and Opinions.

Purpose: To ascertain the preferences of perianesthesia nurses regarding peripheral nerve blocks (PNBs) and their impact on patient recovery after total joint replacement (TJR).

Design: Survey of perianesthesia nurses at a single medical center.

Methods: Fifty-nine perianesthesia nurses completed a 23-question survey on PNBs for TJR.

The effect of scoliosis on surface landmarks for lumbar plexus block: a MRI-based retrospective case-control series.

Background: Degenerative scoliosis (DS) may affect surface landmarks for performance of lumbar plexus (LP) block. We hypothesized the extent of any difference in surface landmarks could be calculated by a formula based on measured degree of DS, body mass index, sex, and age.

Methods: We retrospectively searched our radiology database until 113 consecutive adult patients with DS were identified with lumbar spine radiographs and magnetic resonance imaging examinations performed.

Ultrasound Assessment of Gastric Volume After Bariatric Surgery: A Case Report.

Gastric ultrasound is emerging as a tool that can be used to assess gastric content and volume in patients with an unknown fasting history. This information can impact the choice of anesthetic technique or the timing of surgery due to the presumed risk of aspiration. Currently, no data are available regarding the use of gastric ultrasound for patients who have had prior gastric operations, despite the increasing number of patients undergoing bariatric surgery.

Clinical application of limiting laryngeal mask airway cuff pressures utilizing inflating syringe intrinsic recoil.

Background: Overinflation of the laryngeal mask airway (LMA) cuff may cause many of the complications associated with the use of the LMA. There is no clinically acceptable (cost effective and practical) method to ensure cuff pressure is maintained below the manufacturer's recommended maximum value of 60 cm HO (44 mmHg). We studied the use of the intrinsic recoil of the LMA inflating syringe as an effective and practical way to limit cuff pressures at or below the manufacturer's recommended values.

Peripheral nerve blocks and postoperative physical therapy: a single-institution survey of physical therapists' preferences and opinions.

Background And Aims: Our aim was to ascertain the opinions and preferences of physical therapists with regard to use of peripheral nerve blocks and their impact on the recovery of patients undergoing total joint replacement.

Methods: We conducted an anonymous 24-question survey of 20 full-time inpatient physical therapists at a single tertiary care medical center.

Results: One respondent indicated they never work with patients who have undergone total joint replacement surgery.

Whole-exome sequencing of a family with local anesthetic resistance.

Background: Local anesthetics (LA) work by blocking sodium conductance through voltage-gated sodium channels. Complete local anesthetic resistance is infrequent, and the cause is unknown. Genetic variation in sodium channels is a potential mechanism for local anesthetic resistance.

ANESTHETIC MANAGEMENT OF FEMORAL FRACTURE REPAIR IN A PATIENT WITH CERVICAL MYELOPATHY, AUTONOMIC DYSFUNCTION, AND DIFFICULT AIRWAY.

Spinal stenosis is a potentially serious condition that can lead to myelopathies and autonomic instability, both of which, as a result, may complicate anesthetic management. Additionally, neuraxial anesthesia appears to increase the risk of worsened neurological outcomes in this population. A 56-year-old female with spinal stenosis, autonomic dysfunction, and known difficult airway who required anesthesia for repair of a femur fracture is presented.

Opioid consumption in total knee arthroplasty patients: a retrospective comparison of adductor canal and femoral nerve continuous infusions in the presence of a sciatic nerve catheter.

Objective: To compare opioid consumption among patients who receive a continuous adductor canal block (ACB) versus continuous femoral nerve block (FB) for total knee arthroplasty analgesia in the presence of an intermittent sciatic nerve catheter (iSB).

Design: Matched cohort retrospective study.

Setting: Mayo Clinic, Jacksonville, FL.

THE USE OF PARAVERTEBRAL BLOCKADE FOR ANALGESIA AFTER ANTERIOR-APPROACH TOTAL HIP ARTHROPLASTY.

Background: Anterior approaches for total hip arthroplasty (ATHA) are becoming increasingly popular. We postulated that the use of PVB of the T12, L1, and L2 roots would provide adequate analgesia for ATHA while allowing motor sparing.

Methods: The medical records of 20 patients undergoing primary ATHA were reviewed.

Breast cancer recurrence in patients receiving epidural and paravertebral anesthesia: a retrospective, case-control study.

Purpose: Studies have suggested an association between the use of regional paravertebral or epidural anesthesia and a reduction in tumor recurrence following breast cancer surgery. To examine this relationship we performed a retrospective case-control study of patients undergoing breast cancer surgery receiving regional, regional and general, or general anesthesia.

Methods: A retrospective chart review was performed of patients undergoing surgery for stage 0 to III breast cancer.

Lumbar plexus block surface landmarks as assessed by computed axial tomography in adult patients with scoliosis: a case series.

Background And Objectives: Lumbar plexus (LP) block is a common and useful regional anesthesia technique. Surface landmarks used to identify the LP in patients with healthy spines have been previously described, with the distance from the spinous process (SP) to the skin overlying the LP being approximately two-thirds the distance from the SP to the posterior superior iliac spine (PSIS) (SP-LP:SP-PSIS ratio). In scoliotic patients, rotation of the central neuraxis may make these surface landmarks unreliable, possibly leading to an increased block failure rate and an increased incidence of complications.

Ultrasound-guided transversus abdominis plane blocks for patients undergoing laparoscopic hand-assisted nephrectomy: a randomized, placebo-controlled trial.

Postoperative pain is a common complaint following living kidney donation or tumor resection using the laparoscopic hand-assisted technique. To evaluate the potential analgesic benefit of transversus abdominis plane blocks, we conducted a randomized, double-blind, placebo-controlled study in 21 patients scheduled to undergo elective living-donor nephrectomy or single-sided nephrectomy for tumor. Patients were randomized to receive either 20 mL of 0.

Success of ultrasound guided popliteal sciatic nerve catheters is not influenced by nerve stimulation.

Background: There is debate as to whether nerve stimulation (NS) is required to place peripheral nerve catheters when using ultrasound (US) guidance. There is conflicting evidence for whether stimulating catheters improve postoperative analgesia compared to non-stimulating catheters. The use of US in combination with NS has been shown to be superior to NS alone in terms of popliteal nerve blockade.

Advances in drug safety.

The operating room offers a unique setting where anesthetics, preoperative medications, patient comorbidities, and surgery all merge. Anesthesiologists are responsible for combining these concerns into a dependable and safe approach. From formulation to administration, enhancements in nearly every aspect of a given drug have improved the ability of anesthesiologists to accomplish this.