Bezold-Jarisch Reflex Presenting With Bradypnea, Bradycardia, and Hypotension Following Combined Spinal Epidural Prior to Cesarean Section: A Case Report.

The Bezold-Jarisch reflex (BJR) is an inhibitory reflex characterized by bradycardia, hypotension, and apnea originating from ventricular mechanoreceptors. BJR is an uncommon but serious complication of neuraxial anesthesia. We present a case of a 33-year-old female undergoing combined spinal-epidural anesthesia prior to cesarean delivery who developed profound BJR, resulting in emergent actions. Within minutes of injection, she became severely bradycardic (HR: 17 bpm) and hypotensive (SBP: 30s mmHg) with bradypnea (RR: 6/min) and was treated with epinephrine. Fetal bradycardia prompted emergency cesarean section. Following delivery, the patient developed ventricular tachycardia, which was treated with intravenous fluids and cardiac monitoring. Both patient and neonate were discharged in stable condition on postoperative day four. This case illustrates the rapid maternal and fetal compromise associated with BJR during neuraxial anesthesia and the need for prompt recognition and treatment. Key steps include stopping anesthesia, intravenous fluid, left-lateral positioning, judicious vasopressors, fetal monitoring, and preparing for emergent delivery.

Carotid Sinus Tumor-Induced Positional Bradycardia and Hypotension After Extubation: A Case Report.

Regional progression of head and neck malignancies can lead to carotid sinus tumors, causing hemodynamic instability and carotid sinus syndrome (CSS). A 60-year-old male with tonsillar squamous cell carcinoma developed profound positional bradycardia and hypotension immediately after extubation following dental extraction. The patient developed recurrent episodes of positional bradycardia and hypotension, leading to eventual pacemaker placement. Further workup revealed a large mass in the left neck and necrotic cervical lymphadenopathy, indicating CSS from malignancy compression. This case highlights the need for consideration of CSS in patients with known head and neck malignancy, particularly when postural hypotension and bradycardia are present.

Analgesic Techniques for Rib Fractures-A Comprehensive Review Article.

PURPOSE OF REVIEW: Rib fractures are a common traumatic injury that has been traditionally treated with systemic opioids and non-opioid analgesics. Due to the adverse effects of opioid analgesics, regional anesthesia techniques have become an increasingly promising alternative. This review article aims to explore the efficacy, safety, and constraints of medical management and regional anesthesia techniques in alleviating pain related to rib fractures. RECENT FINDINGS: Recently, opioid analgesia, thoracic epidural analgesia (TEA), and paravertebral block (PVB) have been favored options in the pain management of rib fractures. TEA has positive analgesic effects, and many studies vouch for its efficacy; however, it is contraindicated for many patients. PVB is a viable alternative to those with contraindications to TEA and exhibits promising outcomes compared to other regional anesthesia techniques; however, a failure rate of up to 10% and adverse complications challenge its administration in trauma settings. Serratus anterior plane blocks (SAPB) and erector spinae blocks (ESPB) serve as practical alternatives to TEA or PVB with lower incidences of adverse effects while exhibiting similar levels of analgesia. ESPB can be performed by trained emergency physicians, making it a feasible procedure to perform that is low-risk and efficient in pain management. Compared to the other techniques, intercostal nerve block (ICNB) had less analgesic impact and required concurrent intravenous medication to achieve comparable outcomes to the other blocks. The regional anesthesia techniques showed great success in improving pain scores and expediting recovery in many patients. However, choosing the optimal technique may not be so clear and will depend on the patient's case and the team's preferences. The peripheral nerve blocks have impressive potential in the future and may very well surpass neuraxial techniques; however, further research is needed to prove their efficacy and weaknesses.

Middle age, a key time point for changes in birdsong and human voice.

Voice changes caused by natural aging and neurodegenerative diseases are prevalent in the aging population and diminish quality of life. Most treatments involve behavioral interventions that target the larynx because of a limited understanding of central brain mechanisms. The songbird offers a unique entry point into studying age-related changes in vocalizations because of a well-characterized neural circuitry for song that shares homology to human vocal control areas. Previously we established a translational dictionary for evaluating acoustic features of birdsong in the context of human voice measurements. In the present study, we conduct extensive analyses of birdsongs from young, middle-aged, and old male zebra finches. Our findings show that birdsongs become louder with age, and changes in periodic energy occur at middle age but are transient; songs appear to stabilize in old birds. Furthermore, faster songs are detected in finches at middle age compared with young and old finches. Vocal disorders in humans emerge at middle age, but the underlying brain pathologies are not well identified. The current findings will motivate future investigations using the songbird model to identify possible brain mechanisms involved in human vocal disorders of aging. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Common Terminology and Acoustic Measures for Human Voice and Birdsong.

Purpose The zebra finch is used as a model to study the neural circuitry of auditory-guided human vocal production. The terminology of birdsong production and acoustic analysis, however, differs from human voice production, making it difficult for voice researchers of either species to navigate the literature from the other. The purpose of this research note is to identify common terminology and measures to better compare information across species. Method Terminology used in the birdsong literature will be mapped onto terminology used in the human voice production literature. Measures typically used to quantify the percepts of pitch, loudness, and quality will be described. Measures common to the literature in both species will be made from the songs of 3 middle-age birds using Praat and Song Analysis Pro. Two measures, cepstral peak prominence (CPP) and Wiener entropy (WE), will be compared to determine if they provide similar information. Results Similarities and differences in terminology and acoustic analyses are presented. A core set of measures including frequency, frequency variability within a syllable, intensity, CPP, and WE are proposed for future studies. CPP and WE are related yet provide unique information about the syllable structure. Conclusions Using a core set of measures familiar to both human voice and birdsong researchers, along with both CPP and WE, will allow characterization of similarities and differences among birds. Standard terminology and measures will improve accessibility of the birdsong literature to human voice researchers and vice versa. Supplemental Material https://doi.org/10.23641/asha.7438964.