RESUMO
The regional anesthesia literature was quite active in the calendar year 2013. In typical fashion, the literature was composed of articles representing neuraxial analgesia, peripheral nerve blocks, patient outcomes, regional anesthesia adjuvant medications, and patient safety. The goal of this article is to summarize and present the most relevant articles from each of these arenas.
Assuntos
Anestesia por Condução/métodos , Anestésicos Locais/administração & dosagem , Bloqueio Nervoso/métodos , Analgésicos/administração & dosagem , Anestesia por Condução/efeitos adversos , Anestésicos Locais/efeitos adversos , Humanos , Bloqueio Nervoso/efeitos adversosRESUMO
Methylene blue is a useful therapy for catecholamine-resistant vasoplegic shock. Three cases of methylene blue administration for the treatment of catecholamine-resistant hypotension during orthotopic liver transplantation are presented.
Assuntos
Inibidores Enzimáticos/uso terapêutico , Hipotensão/tratamento farmacológico , Transplante de Fígado/efeitos adversos , Azul de Metileno/uso terapêutico , Vasoconstritores/uso terapêutico , Adolescente , Adulto , Catecolaminas/uso terapêutico , Resistência a Medicamentos , Feminino , Humanos , Hipotensão/etiologia , Cuidados Intraoperatórios/métodos , Masculino , Pessoa de Meia-Idade , Choque Cirúrgico/tratamento farmacológicoRESUMO
OBJECTIVE. Osteogenesis imperfecta is a connective tissue disorder that results from the inability to produce normal collagen. Eight types are described; type II is considered the lethal variant. Because of abnormal collagen production, these patients possess many anatomic and functional abnormalities. In addition to the obvious brittle bones, osteogenesis imperfecta patients may also possess respiratory, cardiac, spinal, endocrine, and hematologic abnormalities. These numerous derangements can lead to a challenging perioperative course. CASE REPORT. This report describes a case of a 27-year-old woman, G1P0 with history of type III osteogenesis imperfecta presenting at 31+ weeks with preterm premature rupture of membranes, lower extremity edema, and constipation. Because of progressive labor and cephalopelvic disproportion, an urgent cesarean section was performed under general anesthesia. Intraoperative coagulopathy was noted. After hemostasis was achieved, a colonic mass below the splenic flexure that measured 20 × 10 cm was revealed. General surgery was consulted intraoperatively, and a rectosigmoid resection was performed for a presumed colonic pseudo-obstruction. Patient tolerated the procedure well and was extubated at the completion of the case. The patient was discharged home on postoperative day 5. CLINICAL CHALLENGES. (a) Preoperative assessment of an osteogenesis imperfecta patient, (b) determination of anesthetic type, (c) management of hemorrhage/cardiovascular instability, and (d) management of hyperthermia. CONCLUSIONS. This case report illustrates that, with proper knowledge of this disease state, osteogenesis imperfecta patients can undergo a safe anesthetic during a potentially challenging combined cesarean section/colonic resection.
