A&A practice最新文献

{"title":"A Paradoxical Increase in Ventricular Arrhythmia After a Left Stellate Ganglion Block: A Case Report.","authors":"Sharon M Bouvette, Amir L Butt, Aimee Pak","doi":"10.1213/XAA.0000000000002204","DOIUrl":"https://doi.org/10.1213/XAA.0000000000002204","url":null,"abstract":"<p><p>Ultrasound-guided left-sided or bilateral stellate ganglion block (SGB) has emerged as an effective bedside intervention for malignant ventricular arrhythmias (VA) refractory to conventional therapies, with demonstrated safety and efficacy in multiple studies. We report a medically complex patient with presumed genotype-negative Long QT Syndrome (LQTS) who experienced a sudden, transient increase in arrhythmic events shortly after an uncomplicated left-sided ultrasound-guided SGB. To our knowledge, this is the first documented case of increased VA burden following left-sided SGB, highlighting the potential for paradoxical effects and the need for cautious application in patients with comorbidities.</p>","PeriodicalId":56372,"journal":{"name":"A&A practice","volume":"20 5","pages":"e02204"},"PeriodicalIF":0.6,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824253","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intravenous Acetaminophen for Shoulder-Tip Pain During Awake Laparoscopic Surgery in Early Pregnancy: A Case Report.","authors":"Airi Akashi, Tetsuya Shimada, Takehiko Ikeda","doi":"10.1213/XAA.0000000000002205","DOIUrl":"https://doi.org/10.1213/XAA.0000000000002205","url":null,"abstract":"<p><p>A 27-year-old primigravida at 9 weeks' gestation underwent emergency laparoscopic ovarian surgery under combined spinal-epidural anesthesia. During pneumoperitoneum, bilateral shoulder-tip pain developed after Trendelenburg positioning. Intravenous acetaminophen (1000 mg) was initiated, and pain improved within 10 minutes, allowing surgery to continue without lowering insufflation pressure, administering additional opioids or sedatives, or converting to general anesthesia. Pain resolved after desufflation. Maternal oxygenation remained stable, and fetal cardiac activity was reassuring before and after surgery. This case suggests that intravenous acetaminophen may be an opioid-sparing rescue option for intraoperative shoulder-tip pain during awake laparoscopy in early pregnancy.</p>","PeriodicalId":56372,"journal":{"name":"A&A practice","volume":"20 5","pages":"e02205"},"PeriodicalIF":0.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Transesophageal Echocardiography-Guided Anesthetic Management of Intravenous Leiomyomatosis With Right Atrial Extension: A Case Report.","authors":"Miyako Kobayashi, Takuya Okada, Norihiko Obata","doi":"10.1213/XAA.0000000000002198","DOIUrl":"https://doi.org/10.1213/XAA.0000000000002198","url":null,"abstract":"<p><p>Intravenous leiomyomatosis (IVL) is a rare benign smooth muscle tumor that can extend into the heart, posing major anesthetic challenges. We report a 57-year-old woman with IVL extending from the uterus through the inferior vena cava into the right atrium. A multidisciplinary team performed single-stage intracardiac tumor resection under cardiopulmonary bypass with hysterectomy and bilateral salpingo-oophorectomy. Continuous transesophageal echocardiography (TEE) enabled real-time assessment of tumor mobility and safe cannulation. The patient recovered uneventfully. This case highlights the essential role of TEE and teamwork in managing IVL with intracardiac extension.</p>","PeriodicalId":56372,"journal":{"name":"A&A practice","volume":"20 5","pages":"e02198"},"PeriodicalIF":0.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13132084/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824250","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Segmental Spinal Anesthesia With Fascial Plane Block for Cesarean Delivery in Severe Mitral Stenosis: A Case Report.","authors":"Mukesh K Prasad, Tripta Kumari, Kanchan Rani","doi":"10.1213/XAA.0000000000002201","DOIUrl":"https://doi.org/10.1213/XAA.0000000000002201","url":null,"abstract":"<p><p>Severe mitral stenosis (MS) during pregnancy represents a fixed cardiac output state and poses major anesthetic challenges during elective cesarean delivery (CD). Conventional single-shot spinal anesthesia may precipitate profound hypotension in these patients. We report two high-risk parturients with severe MS, classified as New York Heart Association (NYHA) class III, who underwent elective CD. Both patients were managed using low-dose segmental spinal anesthesia supplemented with ultrasound-guided erector spinae plane block (ESPB) and invasive hemodynamic monitoring. In both cases, the procedures were completed with stable intraoperative hemodynamics and effective postoperative analgesia, without cardiopulmonary complications. The combination of segmental spinal anesthesia with regional fascial plane blocks and invasive monitoring may represent a viable alternative anesthetic strategy for elective CD in carefully selected parturients with severe MS.</p>","PeriodicalId":56372,"journal":{"name":"A&A practice","volume":"20 5","pages":"e02201"},"PeriodicalIF":0.6,"publicationDate":"2026-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147824219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When \"Inspiration\" Is Not Enough: A Case for Controlling \"Expiration\".","authors":"Timur Yurttas, Markus M Luedi, Marcelo Gama de Abreu, Marcus J Schultz","doi":"10.1213/XAA.0000000000002206","DOIUrl":"https://doi.org/10.1213/XAA.0000000000002206","url":null,"abstract":"","PeriodicalId":56372,"journal":{"name":"A&A practice","volume":"20 4","pages":"e02206"},"PeriodicalIF":0.6,"publicationDate":"2026-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789988","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Anesthetic Management in Pediatric Limb Replantation After Traumatic Amputation.","authors":"Sarah R Stender, Charles A Daly, Nicole C McCoy","doi":"10.1213/XAA.0000000000002197","DOIUrl":"https://doi.org/10.1213/XAA.0000000000002197","url":null,"abstract":"<p><p>For children who undergo major limb replantation, there is limited guidance for intraoperative anticoagulation protocols or vasopressor use to protect graft patency. We report a case of a 2-year-old female who underwent successful arm replantation after traumatic amputation with a course complicated by hemorrhage and hemodynamic instability. To protect vessel graft patency, we anticoagulated the patient and limited vasopressor use, both of which made resuscitation difficult. Despite these challenges, the replanted limb remained viable. Although guidelines are needed, this case highlights our experience and recommendations for using anticoagulation and vasopressors during major limb replantation in the pediatric population.</p>","PeriodicalId":56372,"journal":{"name":"A&A practice","volume":"20 4","pages":"e02197"},"PeriodicalIF":0.6,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuraxial Anesthesia in a Parturient With Migrated Gluteal Biopolymer: A Case Report.","authors":"Haley Mullins, Nicole Z Spence, Rachel Achu-Lopes","doi":"10.1213/XAA.0000000000002196","DOIUrl":"https://doi.org/10.1213/XAA.0000000000002196","url":null,"abstract":"<p><p>Gluteal biopolymer injections can migrate unpredictably into the lumbosacral region, creating potential barriers to neuraxial anesthesia and risking contamination of neuraxial structures. We report a case of successful epidural anesthesia in a 32-year-old primigravida with magnetic resonance imaging (MRI)-confirmed biopolymer migration to L5-S1. An epidural was placed at L1-L2 under ultrasound guidance during labor and subsequently used uneventfully for cesarean delivery. This case demonstrates that neuraxial anesthesia may be feasible when imaging is used to identify safe procedural sites and highlights the importance of preprocedural planning to optimize maternal and neonatal outcomes in patients with migrated biopolymers.</p>","PeriodicalId":56372,"journal":{"name":"A&A practice","volume":"20 4","pages":"e02196"},"PeriodicalIF":0.6,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789831","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Peripheral Nerve Block Use for Breast Contouring Surgery.","authors":"Krishna Sinha, Alexander W Lipinski, Cyrus J Berglin, Shelley S Noland, Lopa Misra","doi":"10.1213/XAA.0000000000002182","DOIUrl":"https://doi.org/10.1213/XAA.0000000000002182","url":null,"abstract":"","PeriodicalId":56372,"journal":{"name":"A&A practice","volume":"20 4","pages":"e02182"},"PeriodicalIF":0.6,"publicationDate":"2026-04-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147789760","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Accidental Molar Ingestion During Postoperative Recovery After Thoracic Surgery: A Case Report.","authors":"Vasili Chernishof, Ashley Osumi, Rodney Kevin McKeever","doi":"10.1213/XAA.0000000000002167","DOIUrl":"https://doi.org/10.1213/XAA.0000000000002167","url":null,"abstract":"<p><p>Accidental ingestion of a permanent tooth in an adult during high-risk surgery is rare but can lead to serious complications, including gastrointestinal obstruction, perforation, and mediastinitis. A 65-year-old woman with a history of hypertension, type 2 diabetes, and granulosa cell tumor underwent wedge resection and excisional biopsy via video-assisted thoracoscopic surgery (VATS). Preoperative evaluation revealed multiple missing, cracked, and discolored teeth, including a loose mandibular third molar. Despite previous preoperative counseling, the patient was unable to obtain dental treatment due to multiple barriers to care. Despite careful airway management and precautions taken intraoperatively, the molar was dislodged and ingested postextubation. The patient remained asymptomatic without experiencing oxygen desaturation, coughing, choking, excessive salivation, or bleeding. The tooth was detected only after a routine postoperative chest radiograph which incidentally identified a radiopaque foreign object, confirmed as the ingested tooth. Urgent endoscopic retrieval by gastroenterology successfully removed the tooth without complications, and the patient recovered uneventfully. This case highlights a rare perioperative complication and underscores the need for vigilance throughout the perioperative period in patients with compromised dentition. It emphasizes the importance of interdisciplinary communication, timely recognition of dental injuries, and preventive strategies including preoperative dental assessment and protective airway techniques to improve patient safety in high-risk surgical settings.</p>","PeriodicalId":56372,"journal":{"name":"A&A practice","volume":"20 4","pages":"e02167"},"PeriodicalIF":0.6,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Automated Identification of Cardiopulmonary Disease Cases for Preoperative Risk Stratification Using Machine Learning: A Retrospective Analysis.","authors":"Ishan Aggarwal, Christopher Rhee, Mamta Chura, Vaibhav Bora, Devarapalli M Reddy","doi":"10.1213/XAA.0000000000002183","DOIUrl":"https://doi.org/10.1213/XAA.0000000000002183","url":null,"abstract":"<p><strong>Background: </strong>Preoperative chart review is time-consuming and prone to errors, particularly for cardiopulmonary conditions that impact anesthetic planning. We developed a guideline-aligned \"clinical insight bot\" that mines free-text documentation to surface perioperative cardiovascular risk signals relevant to the 2024 Mult Society perioperative guideline for noncardiac surgery.</p><p><strong>Methods: </strong>We analyzed 1000 de-identified medical cases from the PhysioNet MIMIC database. Medical terminology was extracted using regex-based NLP and categorized into 13 clinical specialties. Text features were encoded using TF-IDF vectorization and 1536-dimensional semantic embeddings stored in a PostgreSQL vector database (pgvector). Four machine learning models-Logistic Regression, Random Forest, Support Vector Machine (SVM), and Naive Bayes-were trained with stratified fivefold cross-validation to classify cases as \"cardiopulmonary-only\" versus \"mixed/other.\" Performance was evaluated using accuracy, precision, recall, and F1 score, with statistical comparison via McNemar's test and bootstrap confidence intervals.</p><p><strong>Results: </strong>In a held-out test set of 200 notes (28 positive; 172 negatives; ~14% prevalence), a linear support vector machine achieved the best overall balance (F1 ≈ 0.71), with high precision (positive predictive value 0.94) and very low false positive rate (FPR) (1/172 ≈ 0.6%). False negatives were the dominant residual error class. The pipeline processed documents near-instantaneously and, when scaled to 1000 notes, replaced on the order of tens of clinician review hours (≈100× efficiency gain) while maintaining performance across common preoperative document types.</p><p><strong>Conclusions: </strong>A lightweight, guideline-aligned insight bot can transform unstructured preoperative notes into concise, stepwise prompts that flag cardiovascular risk signals before the day of surgery. High precision with a very low FPR supports safe integration with anesthesiology workflows by minimizing paging noise, whereas time savings create operational and financial value. Future work should emphasize multicenter validation, structured data fusion (including labs, imaging, and vitals) to improve sensitivity, and prospective evaluation of downstream clinical and operational outcomes.</p>","PeriodicalId":56372,"journal":{"name":"A&A practice","volume":"20 4","pages":"e02183"},"PeriodicalIF":0.6,"publicationDate":"2026-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693843","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}