It Is Not Always the Epidural: A Case Report of Anterior Spinal Artery Ischemia in a Trauma Patient

This report describes a trauma patient who developed hypotension and lower extremity weakness after epidural placement for multiple rib fractures. Initially, hypotension was attributed to neuraxial sympathectomy. However, physical examination also indicated anterior spinal artery ischemia. Regional anesthesia and acute pain teams must be able to both identify contraindications and complications of regional techniques and discern when complications are not a result of regional interventions to initiate prompt management and definitive care.
Source: A&A Case Reports - Category: Anesthesiology Tags: Case Reports Source Type: research

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Back in May, Bruce Schoneboom wrapped up his appointment to the HHS Pain Management Best Practices Inter-Agency Task Force. The group determined best practices for managing chronic and acute pain—and addressed judicious prescribing of opioids. If you didn’t know: The CDC reports there are 192 overdose deaths in the U.S. every day. Forty percent of The post Dr. Bruce Schoneboom and the HHS Pain Task Force appeared first on Johns Hopkins Nursing Magazine.
Source: Nursing Blogs at Johns Hopkins University - Category: Nursing Authors: Tags: New On the Pulse DNP nurse anesthesiology nurse anesthetist pain month Source Type: blogs
Conclusions The authors conclude that sympathetic blocks may be therapeutic in patients with complex regional pain syndrome regardless of preprocedure limb temperatures. The effects of sympathetic blocks do not predict the success of spinal cord stimulation.
Source: Anesthesiology - Category: Anesthesiology Source Type: research
Publication date: Available online 6 September 2019Source: Anaesthesia &Intensive Care MedicineAuthor(s): G. Baranidharan, Ibrahim MohamedAbstractNeuropathic pain is a well-recognized chronic pain condition. This can have a significant impact in patients' quality of life. Neuromodulation is defined by the International Neuromodulation Society as ‘the therapeutic alteration of activity in the central or peripheral nervous system either electrically or pharmacologically’. Electrical stimulation can be performed at the motor cortex, deep brain, spinal cord, dorsal root ganglion, peripheral nerve and peripheral...
Source: Anaesthesia and intensive care medicine - Category: Anesthesiology Source Type: research
CONCLUSIONS: The use of combined epidural and general anesthesia followed by postoperative epidural analgesia during the first 48 hours after multilevel thoracolumbar decompression and fusion surgery had a significant positive effect on pain management, cellular immune function, systemic inflammation, and postoperative cognitive function.Clinical trial registration no.: 115080510080 (http://rosrid.ru). PMID: 31491757 [PubMed - as supplied by publisher]
Source: Journal of Neurosurgery.Spine - Category: Neurosurgery Authors: Tags: J Neurosurg Spine Source Type: research
n M Abstract BACKGROUND: Acute pain is a common reason for calling emergency medical services (EMS) and can require medication depending on the pain intensity. German EMS personnel feel strong pressure to reduce a patient's pain but are restricted by law. Currently, German federal law only allows the administration of opioid-containing drugs by or on the order of a physician, while in other European countries (e.g. Switzerland and The Netherlands) the administration of opioid-based analgesia by trained and certified paramedics is common practice. Consequently, a patient in Germany experiencing ...
Source: Der Anaesthesist - Category: Anesthesiology Authors: Tags: Anaesthesist Source Type: research
Authors: Wu J, Ku SC, Ko AL Abstract A 51-year-old man with metastatic renal cell carcinoma whose fentanyl requirement was 3000-4000 µg/h in inpatient hospice presented for a thoracic (T) vertebral 4-10 posterior spinal fusion for a lytic T7 compression fracture. He underwent total intravenous (IV) anesthesia with propofol, remifentanil, and ketamine; liposome bupivacaine was locally infiltrated at the end of the case. Following extubation on postoperative day (POD) 1, he had severe pain refractory to high-dose IV fentanyl patient control analgesia and ketamine infusion. His pain dramatically improved ...
Source: Journal of Pain and Palliative Care Pharmacotherapy - Category: Palliative Care Tags: J Pain Palliat Care Pharmacother Source Type: research
Purpose of review The aim of this article is to review the evidence regarding the anesthetic management of blood loss, pain control, and position-related complications of adult patients undergoing complex spine procedures. Recent findings The most recent evidence of the anesthetic management of complex spine surgery was identified with a systematic search and graded. In our review, prophylactic tranexamic acid and optimal prone positioning were shown to be effective blood conservation strategies with minimal risks to the patients. Cell saver was cost-effective in complex surgeries with expected blood loss of greater t...
Source: Current Opinion in Anaesthesiology - Category: Anesthesiology Tags: NEUROANESTHESIA: Edited by Lingzhong Meng Source Type: research
Abstract Cancer patients quite commonly will report different types of pain associated with the disease substrate. Systemic analgesia and radiotherapy provide only partial pain relief in the majority of these patients. Interventional Oncology techniques for pain management and mobility improvement in cancer patients include percutaneous techniques such as neurolysis, ablation and augmentation (both in the spine and peripheral skeleton) as well as trans-arterial embolization. Percutaneous neurolysis acts indirectly providing regional anesthesia whilst the rest of the aforementioned techniques act directly upon the ...
Source: Presse Medicale - Category: General Medicine Authors: Tags: Presse Med Source Type: research
CONCLUSION: Intrathecal (S)-(+)-Ketoprofen caused dose-dependent neurohistopathological changes in rats on days 3 and 7 after injection, suggesting that (S)-(+)-Ketoprofen should not be intrathecally administered. PMID: 31371174 [PubMed - as supplied by publisher]
Source: Revista Brasileira de Anestesiologia - Category: Anesthesiology Tags: Rev Bras Anestesiol Source Type: research
Conclusion At first glance, the future prospects for the hospital industry’s surgery business look promising. Profit margins for most procedure lines remain solid, and an aging population will fuel growth in a broad array of surgical interventions. However, demographic trends are not the sole driver of surgery volumes—technological and competitive forces will also exert a significant influence on the future course of surgery. On the technology front, advances in biomedical engineering will create new surgical interventions while rendering existing surgical procedures obsolete. Technologi...
Source: MDDI - Category: Medical Devices Authors: Tags: Digital Health Source Type: news
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