MedWorm: Anesthesiology Top 20

One-week and 3-month outcomes after an emergency department visit for undifferentiated musculoskeletal low back pain.

Pain Physician — Tue, 24 Jan 2012 19:48:41 +0100

CONCLUSION: There is substantial short- and longer-term morbidity and ongoing analgesic use among patients who present to an ED with undifferentiated musculoskeletal low back pain. PMID: 22265130 [PubMed - in process] (Source: Pain Physician)

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Clinical Signs of Temporomandibular Disorders and Various Pain Conditions Among Children 6 to 8 Years of Age: The PANIC Study.

Pain Physician — Sun, 05 Feb 2012 17:36:02 +0100

Conclusion: Clinical signs of TMD and pain symptoms are common in children. The relationship of back pain, neck-shoulder muscle palpation tenderness, and headache with clinical signs of TMD suggests that more attention should be paid to stomatognathic function in children with such pain problems. J Orofac Pain 2012;26:17-25. PMID: 22292136 [PubMed - in process] (Source: Pain Physician)

Awake GlideScope intubation in a critically ill pediatric patient

Pediatric Anesthesia — Mon, 23 Jan 2012 05:00:00 +0100

We report a challenging case of a 10‐year‐old boy with history of biventricular heart failure, pulmonary hypertension, severe asthma, and obesity with a BMI of 37. He presented to our hospital in acute decompensated heart failure. Our anesthesia team was consulted by the pediatric intensivist for urgent airway management in this rapidly deteriorating, premorbid patient. We describe here the use of the GlideScope® in an awake pediatric patient of ASA 4E status with a potentially difficult airway who required to remain in the seated position and thus necessitating a face‐to‐face approach. (Source: Pediatric Anesthesia)

MRI and arthroscopy correlations of the hip: a case-based approach.

Pain Physician — Sun, 05 Feb 2012 17:36:02 +0100

Authors: McCall DA, Safran MR Abstract Disorders of the hip joint can be physically disabling for the patient and a diagnostic challenge for the physician. Advances in imaging the hip with MRI can help the physician determine a more specific diagnosis for patients with acute or chronic hip pain. MRI and particularly magnetic resonance arthrography have helped raised awareness of nonarthritic hip problems and have made the diagnosis of hip problems much easier. Intra-articular and extra-articular processes can be evaluated with MRI; multiple sequences are available to increase the sensitivity and specificity for detecting specific pathology around the hip. Because the hip is a deep joint within a large soft-tissue envelope, MRI more precisely delineates the sources of hip pain by ev...

Postoperative intravenous morphine titration.

Pain Physician — Tue, 24 Jan 2012 19:49:41 +0100

Authors: Aubrun F, Mazoit JX, Riou B Abstract Relief of acute pain during the immediate postoperative period is an important task for anaesthetists. Morphine is widely used to control moderate-to-severe postoperative pain and the use of small i.v. boluses of morphine in the post-anaesthesia care unit allows a rapid titration of the dose needed for adequate pain relief. The essential principle of a titration regimen must be to adapt the morphine dose to the pain level. Although morphine would not appear to be the most appropriate choice for achieving rapid pain relief, this is the sole opioid assessed in many studies of immediate postoperative pain management using titration. More than 90% of the patients have pain relief using a protocol of morphine titration and the mean dose requ...

Subcutaneous abdominal wall masses: radiological reasoning.

Pain Physician — Tue, 24 Jan 2012 19:48:22 +0100

CONCLUSION: Integrating salient imaging findings with clinical history is crucial when approaching the diagnosis of subcutaneous soft-tissue masses. The diagnosis of endometriosis should be entertained when soft-tissue masses are seen in the distribution of a cesarean section scar in a woman of reproductive age. Pain, particularly with a cyclic pattern, is highly suggestive of endometriosis. If endometriosis is suspected on CT or ultrasound, MRI can be performed for further evaluation. Definitive diagnosis is made with biopsy. Because subcutaneous nodules are so amenable percutaneous biopsy, imaging features, although of interest, are somewhat ancillary to the diagnostic workup. PMID: 22268204 [PubMed - in process] (Source: Pain Physician)

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Pathomorphology and treatment of femoroacetabular impingement.

Pain Physician — Sun, 05 Feb 2012 17:36:02 +0100

Authors: Klenke FM, Siebenrock KA Abstract Femoroacetabular impingement is recognized as a major cause of hip pain and early hip joint osteoarthritis in young adults. The dynamic conflict between the femoral neck and the acetabular rim has been shown to result in labral tears, cartilage lesions, and early osteoarthritis. To be successful, the treatment strategy should address the underlying pathomorphology at the femoral neck, the acetabulum, or both. An overview of the various pathomorphologies leading to femoroacetabular impingement and a treatment algorithm intended to preserve the native hip joint should be helpful to the orthopaedic surgeon treating patients with this condition. PMID: 22301238 [PubMed - in process] (Source: Pain Physician)

Respiratory Syncytial Virus Pneumonia Treated with Lower-Dose Palivizumab in a Heart Transplant Recipient

Anesthesiology Research and Practice — Sun, 29 Jan 2012 12:15:47 +0100

Respiratory syncytial virus (RSV) is an important community-acquired pathogen that can cause significant morbidity and mortality in patients who have compromised pulmonary function, are elderly, or are immunosuppressed. This paper describes a 70-year-old man with a remote history of heart transplantation who presented with signs and symptoms of pneumonia. Chest computed tomography (CT) imaging demonstrated new patchy ground glass infiltrates throughout the upper and lower lobes of the left lung, and the RSV direct fluorescence antibody (DFA) was positive. The patient received aerosolized ribavirin, one dose of intravenous immunoglobulin, and one dose of palivizumab. After two months of followup, the patient had improved infiltrates on chest CT, improved pulmonary function testing, and no e...

A Double‐blind, Randomized, Prospective Study of Epidural Steroid Injection vs. The mild® Procedure in Patients with Symptomatic Lumbar Spinal Stenosis

Pain Practice — Thu, 26 Jan 2012 12:10:25 +0100

Conclusions: This study demonstrated that in LSS patients suffering with neurogenic claudication, mild provides statistically significantly better pain reduction and improved functional mobility vs. treatment with ESI. (Source: Pain Practice)

Laryngoscopy in conscious patients with remifentanil: how useful is an “awake look”?

Journal of Clinical Anesthesia — Sun, 29 Jan 2012 12:15:49 +0100

Conclusions: Using remifentanil as the sole analgesic allows evaluation of the larynx with direct laryngoscopy in a conscious patient. A poor Cormack-Lehane grade in a conscious patient may or may not improve with general anesthesia. (Source: Journal of Clinical Anesthesia)

Ethics of treating postoperative pain.

Pain Physician — Tue, 24 Jan 2012 19:49:00 +0100

Authors: Jones JW, McCullough LB Abstract You received a call advising that Mr S. H. Irk was in the emergency room having considerable wound pain following an above-knee amputation you performed 6 months ago. You discharged him from your clinic 6 weeks postoperatively to his primary care physician, still complaining of more pain than usual. Your examination, clinical lab tests, and X-rays do not reveal any serious problems, but he is writhing in pain and begging for relief. Mr Irk has been to a number of different physicians in the interlude including a chiropractor, a pain specialist, several primary care physicians, and a psychiatrist without relief. He has braced up with increasing amounts of analgesics, the latest of which was oral Dilaudid. His last source of pain meds on the ...

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Patient Satisfaction with Residents vs Attending Following Fluoroscopy-Guided Pain Injections.

Pain Physician — Thu, 05 Jan 2012 05:00:00 +0100

Conclusion. Patients treated by residents are more likely to rate their experience as worse compared with the attending. However, majority of patients in both groups were satisfied in that they perceived their procedure as expected or better than expected. PMID: 22221331 [PubMed - as supplied by publisher] (Source: Pain Physician)

Therapy Switching, Augmentation, and Discontinuation in Patients with Osteoarthritis and Chronic Low Back Pain

Pain Practice — Sun, 01 Jan 2012 05:00:00 +0100

Conclusions: This study demonstrates that therapy switching and discontinuation of select pain medications were common among OA and CLBP patients in the U.K. and may result from inadequate pain relief or undesirable side effects. (Source: Pain Practice)

Neurolytic transversus abdominis plane block in the palliative treatment of intractable abdominal wall pain

Journal of Clinical Anesthesia — Sun, 29 Jan 2012 12:15:49 +0100

Abstract: A 45 year old man with metastatic colon cancer presented with uncontrollable abdominal wall pain. Transversus abdominis plane (TAP) block with ropivacaine and methylprednisolone was performed with excellent pain relief, which allowed a significant weaning of the patient's opioid requirements. A second TAP block was performed with a 33% ethanol solution (ethanol and ropivacaine) with excellent pain relief. The neurolytic block appeared to offer better pain control for more than 5 days after placement until the patient finally succumbed to his illness. (Source: Journal of Clinical Anesthesia)

Anesthesia choice could contribute to endovascular stroke therapy outcomes

MedWire News - Anesthesiology — Thu, 26 Jan 2012 12:18:00 +0100

Patients undergoing endovascular therapy for stroke caused by large vessel occlusion may have better outcomes if given local rather than general anesthesia, research suggests. (Source: MedWire News - Anesthesiology)

Ultrasound-guided cannulation of the great saphenous vein at the ankle in infants

British Journal of Anaesthesia — Mon, 16 Jan 2012 05:00:00 +0100

Conclusions Ultrasound facilitates venous puncture of the GSV in the vast majority of infants ≤12 months. Direct visualization via ultrasound is a promising technique for the establishment of venous access in the GSV at the level of the medial malleolus in infants. (Source: British Journal of Anaesthesia)

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Two case reports of the transverse cervical artery description under and below internal jugular veins in securing pediatric central venous catheters by ultrasound echo images

Pediatric Anesthesia — Thu, 26 Jan 2012 12:13:24 +0100

(Source: Pediatric Anesthesia)

The Size 1 ProSeal™ laryngeal mask airway in infants: a randomized, noncrossover study with the Classic™ laryngeal mask airway

Pediatric Anesthesia — Thu, 02 Feb 2012 12:09:21 +0100

Conclusions: We conclude that the size 1 PLMA is a stable, safe, and efficacious airway control device during neonatal and infant anesthesia, allowing higher peak airway pressure during positive pressure ventilation, with fewer mask displacements and gastric insufflations than the cLMA. (Source: Pediatric Anesthesia)

Nerve stimulator versus ultrasound guidance for placement of popliteal catheters for foot and ankle surgery

Journal of Clinical Anesthesia — Sun, 29 Jan 2012 12:15:49 +0100

Conclusions: Ultrasound guidance was associated with less local anesthetic consumption than with the nerve stimulator; however, there was little clinical benefit, as all other outcomes were similar between groups. (Source: Journal of Clinical Anesthesia)

Spinal anaesthesia for caesarean delivery in a parturient with babesiosis and Lyme disease

Anaesthesia — Fri, 20 Jan 2012 12:16:58 +0100

We present a case of a parturient with babesiosis and Lyme disease who was scheduled for elective caesarean section. The caesarean section was performed under spinal anaesthesia, and the patient had a coronary artery dissection 4 days postoperatively. Neuraxial anaesthesia and possible mechanisms for the coronary artery dissection in a patient with babesiosis and Lyme disease are discussed. (Source: Anaesthesia)