RESUMO
ST-elevation myocardial infarction (STEMI) in a trauma patient with solid abdominal organ or vascular injuries can present complex diagnostic and therapeutic challenges. Evidence for managing such demanding cases is scarce, and isolated case reports remain the source of information in treating these patients. We present a patient with traumatic mesenteric and hepatic injuries who developed acute STEMI in the immediate postoperative period.
Assuntos
Infarto do Miocárdio , Intervenção Coronária Percutânea , Infarto do Miocárdio com Supradesnível do Segmento ST , Humanos , Infarto do Miocárdio com Supradesnível do Segmento ST/etiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Infarto do Miocárdio/complicações , Infarto do Miocárdio/terapia , Infarto do Miocárdio/diagnósticoRESUMO
Tracheal bronchus (TB) occurs in 0.1-3% of the population as an accessory bronchus that originates in the trachea, typically supplying the right upper lobe. The presence of a TB can pose unique airway challenges, particularly during procedures that require lung isolation. Here, we describe a case of TB with difficult lung isolation. Careful examination with fiberoptic bronchoscopy permitted double lumen tube positioning without obstruction of the TB. A second case is presented where the presence of TB did not affect anesthetic management. Implications of TB for airway management and strategies for successful one-lung ventilation are discussed.
Assuntos
Intubação Intratraqueal , Ventilação Monopulmonar , Adulto , Idoso , Brônquios/diagnóstico por imagem , Brônquios/cirurgia , Broncoscopia , Feminino , Humanos , Intubação Intratraqueal/métodos , Pulmão , Masculino , Ventilação Monopulmonar/métodos , Traqueia/diagnóstico por imagem , Traqueia/cirurgiaRESUMO
PURPOSE: Paravertebral blocks have gained in popularity and offer the possible benefit of reduced adverse effects when compared with epidural analgesia. Nevertheless, pulmonary complications in the form of inadvertent pleural puncture are still a recognized risk. Also, the traditional paravertebral blocks are often technically difficult even with ultrasound guidance and constitute deep non-compressible area injections. We present our experience with the first three patients receiving ultrasound-guided retrolaminar blocks for managing the pain associated with multiple rib fractures. CLINICAL FEATURES: The vertebral laminae are identified by ultrasound imaging in a paramedian sagittal plane by sequentially visualizing the pleura and ribs, transverse processes, and the corresponding laminae (from lateral to medial). The block needle is guided to contact the lamina, and the local anesthetic injectate is visualized under real-time imaging. A catheter is inserted and used for continuous analgesia. In three consecutive patients, verbal rating scale (VRS) pain scores were reduced from 10/10 to less than 5/10, and no technical difficulties, complications, or adverse effects were encountered. CONCLUSIONS: Successful analgesia was achieved in all three cases utilizing continuous infusion and intermittent boluses with ultrasound-guided retrolaminar blocks. These results show the feasibility of this approach for patients with multiple rib fractures.
Assuntos
Anestésicos Locais/administração & dosagem , Bloqueio Nervoso/métodos , Manejo da Dor/métodos , Fraturas das Costelas/complicações , Adulto , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/etiologia , Medição da Dor , Resultado do Tratamento , Ultrassonografia de Intervenção/métodosRESUMO
Endothelin and angiotensin II are potent vasoconstrictor substances that also can exert proliferative and proinflammatory effects. Dysregulation of these systems can induce or mediate endothelial dysfunction and organ damage in systemic hypertension. Dual-acting angiotensin II and endothelin receptor blockers have been shown to reduce systemic blood pressure in animal models and in hypertensive patients. Preliminary data in smaller human studies have shown that these agents are safe and well tolerated. Larger randomized trials evaluating the efficacy and safety of these agents are underway and show potential as a new class of antihypertensives.