RESUMO
Persistent poststernotomy pain (PSP) is a well?known entity following cardiac surgery done with midline strenotomy. The severity of pain is usually mild to moderate in the majority of the patients. However, a small percentage of patients develop severe and persistent pain and need aggressive treatment. Our patient, a 63?year?old lady developed chronic severe parasternal pain following coronary artery bypass graft surgery. As multiple medications did not relieve her pain effectively, we did an ultrasound?guided pectoral?intercostal fascial plane block to which she responded with excellent and long?lasting pain relief. This is the first such case report of the use of this novel block technique for treating PSP.
RESUMO
Hypertrophic cardiomyopathy with or without left ventricular outflow tract obstruction is characterized by asymmetric hypertrophy of the interventricular septum causing intermittent obstruction of the left ventricular outflow tract. Because Hypertrophic cardiomyopathy is the most common genetic cardiovascular disease, it may present to the anesthesiologist more often than anticipated, sometimes in undiagnosed form during routine preoperative visit. Surgery and anesthesia often complicate the perioperative outcome if adequate monitoring and proper care are not taken. Therefore, a complete understanding of the pathophysiology, hemodynamic changes and anesthetic implications is needed for successful perioperative outcome. We hereby describe the perioperative management of three patients with Hypertrophic cardiomyopathy for different surgical procedures.