Delayed bilateral vocal cord paresis after a continuous interscalene brachial plexus block and endotracheal intubation: A lesson why we should use low concentrated local anesthetics for continuous blocks

Rationale: Recurrent laryngeal nerve block is an uncommon complication that can occur after an interscalene brachial plexus block (ISB), which may lead to vocal cord palsy or paresis. However, if the recurrent laryngeal nerve is blocked in patients with a preexisting contralateral vocal cord palsy following neck surgery, this may lead to devastating acute respiratory failure. Thus, ISB is contraindicated in patients with contralateral vocal cord lesion. To the best of our knowledge, there are no reports of bilateral vocal cord paresis, which occurred after a continuous ISB and endotracheal intubation in a patient with no history of vocal cord injury or surgery of the neck. Patient concerns: A 59 year old woman was planned for open acromioplasty and rotator cuff repair under general anesthesia. General anesthesia was induced following an ISB using 0.2% ropivacaine and catheter insertion for postoperative pain control. Diagnoses: While recovering in the postanesthesia care unit (PACU), however, the patient complained of a sore throat and hoarseness without respiratory insufficiency. On the morning of the first postoperative day, she still complained of mild dyspnea, dysphonia, and slight aspiration. She was subsequently diagnosed with bilateral vocal cord paresis following an endoscopic laryngoscopy examination. Interventions: The continuous ISB catheter was immediately removed and the dyspnea and hoarseness symptoms improved, although mild aspiration during drinking water w...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research

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A 39-year-old male patient without any medical history presented to the Emergency Department with a 1-week history of intermittent fever and chills. He denied having cough, sore throat, abdominal pain, nausea, vomiting, dysuria, or diarrhea. Physical examination revealed tachycardia (heart rate 110 beats/min) without fever (body temperature, 37 °C) or hypotension (blood pressure, 113/67 mm Hg). Abdomen was soft-palpated without tenderness. Standing chest x-ray study (CXR) showed a heterogeneous radiodensity with air-fluid level lesion over the right upper abdomen (Figure 1, black arrow).
Source: The Journal of Emergency Medicine - Category: Emergency Medicine Authors: Tags: Visual Diagnosis in Emergency Medicine Source Type: research
ConclusionAgranulocytosis or pancytopenia usually developed within 2 months after levamisole treatment, but it might be delayed. Agranulocytosis was more likely to occur in females and onset was acute. Levamisole is an effective immunomodulator for OLP patients; however, it should be used with caution and administered with regular blood monitoring.
Source: Journal of the Formosan Medical Association - Category: General Medicine Source Type: research
CONCLUSION: Agranulocytosis or pancytopenia usually developed within 2 months after levamisole treatment, but it might be delayed. Agranulocytosis was more likely to occur in females and onset was acute. Levamisole is an effective immunomodulator for OLP patients; however, it should be used with caution and administered with regular blood monitoring. PMID: 30922614 [PubMed - as supplied by publisher]
Source: J Formos Med Assoc - Category: General Medicine Authors: Tags: J Formos Med Assoc Source Type: research
Abstract PURPOSE: There is no known biological marker or physical assessment to diagnose chronic fatigue syndrome (CFS), leaving physicians to heavily rely on self-report measures regarding the symptoms associated with CFS. Common symptoms of CFS include difficulty sleeping, joint pain, headaches, sore throat, cognitive dysfunction, physical exhaustion, dizziness, and nausea. Because of the overlap among CFS symptoms and autonomic functioning, we examined the association between 2 self-report measures of orthostatic and autonomic symptoms and a physician's report of autonomic functioning (measures of changes in bl...
Source: Clinical Therapeutics - Category: Drugs & Pharmacology Authors: Tags: Clin Ther Source Type: research
Rationale: Extranodal natural killer T-cell lymphoma nasal type (ENKL) is an extremely rare tumor with a very low survival rate. In recent decades, only a few ENKL cases have been published. Presenting a special ENKL case lead the authors to emphasize the primary features of ENKL in early diagnosis and therapy. Here we report an unusual ENKL case which was initially found in the eyes and presented as masqueraded uveitis Patient concerns: A 55 years old female, with vision loss in the right eye for approximately 6 months, and vision blurry, redness and pain in the left eye for 2 weeks, was referred to our hospital. Di...
Source: Medicine - Category: Internal Medicine Tags: Research Article: Clinical Case Report Source Type: research
This study aimed to evaluate the effect of fentanyl-soaked packing as a method of controlling pain after nasal surgeries in a prospective, randomized, double-blind controlled trial. METHODS: Sixty-five patients that have undergone closed nasal bone fracture reduction surgery were included in this study. Thirty-two patients were treated postoperatively with 50 mcg fentanyl-soaked Merocel®, a biodegradable synthetic polyurethane foams packing, and the other 33 patients were treated with saline-soaked packings. To analyze the relative nasal pain control effect of fentanyl, Numeric Rating Scale, patient satisfac...
Source: Journal of Plastic Surgery and Hand Surgery - Category: Surgery Tags: J Plast Surg Hand Surg Source Type: research
Sore throat plus swallowing or breathing difficulties or ear pain predictive of laryngeal cancer, study shows Related items fromOnMedica Tell patients to use paracetamol for sore throat, urge NICE and PHE Call for closer links between GPs and dentists Air pollution link to heightened mouth cancer risk Public awareness of mouth cancer symptoms low, despite sharp rise in cases GPs need better test access to improve cancer diagnosis
Source: OnMedica Latest News - Category: UK Health Source Type: news
We are in the thick of influenza season now, and so it’s natural that if you hear your child start coughing, you wonder: could this be the flu? The flu is different from the common cold, but it’s not always easy to tell them apart, especially at the beginning. The flu usually comes on suddenly, and its symptoms can include fever, runny nose, cough, sore throat, headache, muscle aches, feeling tired, and generally just feeling rotten. Some people have vomiting and/or diarrhea, too. Not everyone has all these symptoms, and the illness can range from mild to severe. So what do you do if you think your child might ...
Source: Harvard Health Blog - Category: Consumer Health News Authors: Tags: Children's Health Cold and Flu Infectious diseases Parenting Source Type: blogs
A 57-year old woman presented for evaluation of swollen glands. She reported several days of worsening sore throat, which was accompanied by swelling to the left side of her neck and jaw. She had no associated dental pain, difficulty breathing, or fevers. Her medical history was notable for deep vein thrombosis, currently on anticoagulation and remote non-Hodgkin's lymphoma in remission.
Source: The Journal of Emergency Medicine - Category: Emergency Medicine Authors: Tags: Visual Diagnosis in Emergency Medicine Source Type: research
​BY CLAUDIA BORNIA &KHALID MALIK, MDAn 18-year-old healthy man presented to the ED with a sore throat. He said the pain had started a day earlier when he took three capsules of Molly and drank heavily at a music festival.The patient reported pain while swallowing, shortness of breath, and pain in his left rib cage after playing basketball a few days earlier. The patient had no jaw or neck pain, coughing, fever, chills, nausea, vomiting, and diarrhea. He had a blood pressure of 126/76 mm Hg, temperature of 98.2°F (orally), heart rate of 70 bpm, respirations of 18 bpm, and oxygen saturation of 100% on room air. The...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
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