Erythroxylum coca
Case reports 1.    ABSTRACT-(2021-3-17) Patient with Severe Restrictive Lung Disease, and Lumbar Syringomyelia, presenting for Total Hip Replacement: The Anesthesia, Ethical, and Professional Challenges. Author: Dr. Robert M Raw MD There are two elements of interest in this unusual case, performed in 2012. The first element concerns the patient’s multiple co- morbid diseases affecting her anesthesia care with high potential for perioperative mortality. The 60-y old lady weighed 51 kg and suffered foremost from (1) severe thoracic scoliosis, (2) post-polio syndrome causing severe weakness in her left arm, (3) an Arnold-Chiari malformation at the base of her skull, (4) cervical hydro-syringomyelia with a fluid-drainage tube into a cerebral ventricle, (5) a lumbar spinal syrinx extending into the cord conus, with a (6) tethered spinal cord, (7) severe restrictive respiratory disease with (8) chronic CO2 retention, and (9) mild respiratory failure. The anesthetic consisted of (a) general anesthesia and ventilation, (b) regional anesthesia consisting of a parasacral sciatic nerve block, a subcostal nerve block and a psoas compartment block combined with (c) a substantive anti-hyperalgesia and opioid avoidance pharmacological strategy. The surgery took 5½ hours, and the patient lost more than 50% of their blood red-cell mass.  The final outcome was excellent. The second interesting aspect of the case is; the anesthesiologist chose to ignore surgeon’s scientifically baseless objections to the sciatic nerve block component, generating discussion of ethical and professionalism aspects of the surgeon’s behavior afterwards.    Full text PDF
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https://www.regional-anesthesia.com            Editor: Dr. Robert Maurice Raw   
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Erythroxylum coca
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Case reports 1.    ABSTRACT-(2021-3-17) Patient with Severe Restrictive Lung Disease, and Lumbar Syringomyelia, presenting for Total Hip Replacement: The Anesthesia, Ethical, and Professional Challenges. Author: Dr. Robert M Raw MD There are two elements of interest in this unusual case, performed in 2012. The first element concerns the patient’s multiple co-morbid diseases affecting her anesthesia care with high potential for perioperative mortality. The 60-y old lady weighed 51 kg and suffered foremost from (1) severe thoracic scoliosis, (2) post- polio syndrome causing severe weakness in her left arm, (3) an Arnold-Chiari malformation at the base of her skull, (4) cervical hydro-syringomyelia with a fluid- drainage tube into a cerebral ventricle, (5) a lumbar spinal syrinx extending into the cord conus, with a (6) tethered spinal cord, (7) severe restrictive respiratory disease with (8) chronic CO2 retention, and (9) mild respiratory failure. The anesthetic consisted of (a) general anesthesia and ventilation, (b) regional anesthesia consisting of a parasacral sciatic nerve block, a subcostal nerve block and a psoas compartment block combined with (c) a substantive anti-hyperalgesia and opioid avoidance pharmacological strategy. The surgery took 5½ hours, and the patient lost more than 50% of their blood red-cell mass.  The final outcome was excellent. The second interesting aspect of the case is; the anesthesiologist chose to ignore surgeon’s scientifically baseless objections to the sciatic nerve block component, generating discussion of ethical and professionalism aspects of the surgeon’s behavior afterwards.    Full text PDF
https://www.regional-anesthesia.com            Editor: Dr. Robert Maurice Raw   
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Erythroxylum coca
Case reports 1.    ABSTRACT-(2021-3-17) Patient with Severe Restrictive Lung Disease, and Lumbar Syringomyelia, presenting for Total Hip Replacement: The Anesthesia, Ethical, and Professional Challenges. Author: Dr. Robert M Raw MD There are two elements of interest in this unusual case, performed in 2012. The first element concerns the patient’s multiple co-morbid diseases affecting her anesthesia care with high potential for perioperative mortality. The 60-y old lady weighed 51 kg and suffered foremost from (1) severe thoracic scoliosis, (2) post-polio syndrome causing severe weakness in her left arm, (3) an Arnold- Chiari malformation at the base of her skull, (4) cervical hydro- syringomyelia with a fluid-drainage tube into a cerebral ventricle, (5) a lumbar spinal syrinx extending into the cord conus, with a (6) tethered spinal cord, (7) severe restrictive respiratory disease with (8) chronic CO2 retention, and (9) mild respiratory failure. The anesthetic consisted of (a) general anesthesia and ventilation, (b) regional anesthesia consisting of a parasacral sciatic nerve block, a subcostal nerve block and a psoas compartment block combined with (c) a substantive anti-hyperalgesia and opioid avoidance pharmacological strategy. The surgery took 5½ hours, and the patient lost more than 50% of their blood red-cell mass.  The final outcome was excellent. The second interesting aspect of the case is; the anesthesiologist chose to ignore surgeon’s scientifically baseless objections to the sciatic nerve block component, generating discussion of ethical and professionalism aspects of the surgeon’s behavior afterwards.    Full text PDF
https://www.regional-anesthesia.com            Editor: Dr. Robert Maurice Raw   
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