RESUMEN
A 60-year-old female patient underwent emergency cadaveric liver transplantation. During the insertion of the pulmonary artery catheter (PAC) through the left innominate vein, advancement of the catheter was not successful and a knot occurred. An interventional radiologist performed antegrade rigid wire insertion into the PAC and succeeded in loosening the knot in the vessel. We report the successful removal of a knot through intervention without additional invasive procedures in a hemodynamically unstable patient with a coagulopathy.
Asunto(s)
Catéteres Cardíacos/efectos adversos , Cateterismo de Swan-Ganz/efectos adversos , Remoción de Dispositivos/métodos , Cuidados Intraoperatorios/efectos adversos , Trasplante de Hígado/métodos , Cateterismo de Swan-Ganz/métodos , Femenino , Humanos , Cuidados Intraoperatorios/métodos , Persona de Mediana Edad , Arteria Pulmonar/cirugíaRESUMEN
OBJECTIVE: The purpose of this study was to compare the analgesic effect of surgical bilateral rectus sheath block (BRSB) and ultrasonography-guidance BRSB in patients undergoing single port laparoscopic surgery (SPLS) for ovarian cyst. STUDY DESIGN: Seventy-five patients were randomly allocated into three groups: the control and ultrasound (US)-guidance group (n=25, each) received BRSB with 10ml of normal saline or 0.5% ropivacaine bilaterally under US guidance at the end of surgery, respectively; the surgical group (n=25) received BRSB with10ml of 0.5% ropivacaine bilaterally just before suturing the surgical site. All patients received intravenous fentanyl 50µg for postoperative pain before emergence from anesthesia. Additional self-administered fentanyl and pain intensity were measured at postoperative 1, 6, 10 and 24h. RESULTS: Demographic characteristics showed no significant group-wise differences. The cumulative amount of fentanyl delivered was significantly lower in the US-guidance and surgical BRSB groups (189.20µg and 187.68µg, respectively) than the control group (286.40µg) on postoperative day 1 (P<0.001). At 24h, the median pain score was significantly lower only in the surgical BRSB group. In addition, opioid-related side effects were decreased in patients who received BRSB (control group 36% vs. US-guidance BRSB group 24% vs. surgical BRSB group 12%). CONCLUSIONS: Both US-guided and surgical BRSB were effective for pain control in patients undergoing SPLS. Thus, surgical BRSB can be performed by gynecologists intra-operatively, for post-operative pain management.
Asunto(s)
Amidas/uso terapéutico , Laparoscopía/efectos adversos , Bloqueo Nervioso/métodos , Quistes Ováricos/cirugía , Dolor Postoperatorio/tratamiento farmacológico , Adulto , Anciano , Femenino , Fentanilo/uso terapéutico , Humanos , Persona de Mediana Edad , Dolor Postoperatorio/etiología , Ropivacaína , Método Simple Ciego , Resultado del Tratamiento , Ultrasonografía Intervencional , Adulto JovenRESUMEN
Regional anesthesia for non-obstetric surgery in parturients is a method to decrease patient and fetal risk during general anesthesia. Thoracic interfascial nerve block can be used as an analgesic technique for surgical procedures of the thorax. The Pecs II block is an interfascial block that targets not only the medial and lateral pectoral nerves, but also the lateral cutaneous branch of the intercostal nerve. Pecto-intercostal fascial block (PIFB) targets the anterior cutaneous branch of the intercostal nerve. The authors successfully performed a modified Pecs II block and PIFB without complications in a parturient who refused general anesthesia for breast surgery.