ABSTRACT
Physicians primarily use palpation of anatomical landmarks to guide the placement of needles when administering neuraxial anesthetics. For patients with anatomical abnormalities such as scoliosis, it is also important for physicians to understand Fryette mechanics and spinal curvature anatomy, as well as preprocedural radiography and ultrasonography, to ensure accuracy in neuraxial anesthetic procedures. The authors report the case of a patient with severe scoliosis who required neuraxial anesthesia for total hip arthroplasty. Using palpation and imaging, his physicians were able to successfully administer a subarachnoid anesthetic injection on the first attempt. The authors discuss considerations for improving success rates of neuraxial anesthetic administration in these patients.
Subject(s)
Anesthetics/administration & dosage , Osteopathic Medicine/methods , Preoperative Care/methods , Scoliosis/diagnosis , Arthroplasty, Replacement, Hip , Humans , Injections, Spinal , Lumbar Vertebrae , Male , Middle Aged , Osteoarthritis, Hip/complications , Osteoarthritis, Hip/surgery , Palpation , Physical Examination , Scoliosis/complications , Subarachnoid Space , Thoracic VertebraeSubject(s)
Chronic Pain/drug therapy , Polypharmacy , Serotonin Syndrome/chemically induced , Adult , Amitriptyline/administration & dosage , Amitriptyline/adverse effects , Amitriptyline/analogs & derivatives , Anti-Allergic Agents/administration & dosage , Anti-Allergic Agents/adverse effects , Antidepressive Agents/administration & dosage , Antidepressive Agents/adverse effects , Carisoprodol/administration & dosage , Carisoprodol/adverse effects , Cetirizine/administration & dosage , Cetirizine/adverse effects , Duloxetine Hydrochloride , Female , Humans , Muscle Relaxants, Central/administration & dosage , Muscle Relaxants, Central/adverse effects , Narcotics/administration & dosage , Narcotics/adverse effects , Thiophenes/administration & dosage , Thiophenes/adverse effects , Tramadol/administration & dosage , Tramadol/adverse effectsABSTRACT
Evaluation of the degree of neuromuscular blockade by the surgeon using clinical criteria alone is unreliable. We report a case of prolonged neuromuscular blockade lasting 5.5 h, where an additional intra-operative dose of neuromuscular relaxant was given at the request of the surgical team. Possible causes of prolonged neuromuscular antagonism are discussed, as is the importance of neuromuscular assessment prior to the administration of additional neuromuscular blocking agents when receiving a surgeon request for additional neuromuscularblockade.
