Management of an Entrapped Epidural Catheter.

Epidural catheters are seldom challenging to remove from patients. The occurrence of knotting in an epidural catheter, resulting in entrapment, is an uncommon complication of epidural catheterization. There is the risk of significant morbidity with a retained catheter, with the potential for infection or nerve injury. This report describes the techniques used in a case where surgical removal of an entrapped epidural was required and discusses other potential strategies for the successful management of this type of complication. In this case, a low thoracic epidural catheter that was inserted into a 68-year-old male for post-operative analgesia proved challenging to remove. After multiple attempts to remove the catheter, a lumbar CT scan and neurosurgical evaluation were obtained. The neurosurgical team decided to perform a right thoracic hemilaminectomy to remove the entrapped catheter. This surgery revealed a knot near the distal tip of the catheter, which likely caused the entrapment of the catheter in the epidural space.

Coring Revisited: A Case Report and Literature Review.

Coring is the retention of material from a medication vial into the needle and syringe, which can ultimately be transfused into a patient, causing adverse outcomes. The purpose of this article is to increase awareness of this underreported finding and to propose solutions to improve the quality of care and decrease fatalities. A 65-year-old male with a significant cardiovascular history was admitted and required an emergent bedside esophagogastroduodenoscopy, for which propofol was being aspirated for IV induction. This resulted in the coring of the vial topper and subsequently a rubber piece in the syringe. The prevention of coring has largely focused on anticipating the shortcomings of currently available medication vials and aspiration techniques. However, these strategies have limitations. Further work can highlight risk-mitigating approaches such as different aspiration techniques, needle or vial types, and prefilled syringes. More importantly, these interventions may reduce perioperative morbidity and mortality.

Opioid-Related Genetic Polymorphisms of Cytochrome P450 Enzymes after Total Joint Arthroplasty: A Focus on Drug-Drug-Gene Interaction with Commonly Coprescribed Medications.

Pharmacogenomic testing, together with the early detection of drug-drug-gene interactions (DDGI) before initiating opioids, can improve the selection of dosage and reduce the risk of adverse drug interactions and therapeutic failures following Total Joint Arthroplasty. The variants of CYP genes can mediate DDGI. Orthopedic surgeons should become familiar with the genetic aspect of opioid use and abuse, as well as the influence of the patient genetic makeup in opioid selection and response, and polymorphic variants in pain modulation.