Erythroxylum coca
Case reports; page 2. 15. A patient had an epidural block placed, with catheter insertion for surgery. It was discovered after surgery that the patient had been fully anticoagulated, and was at risk for epidural hematoma.  Author: Dr. Robert M Raw MD. ABSTRACT: (case = 2003, updated 2021) A patient needed a below knee amputation for reasons of having leg ischemia. The patient was a heavy smoker with severe emphysema, and a history of an extended period of ICU lung-ventilation after a previous surgery under general anesthesia. It was decided to operate the patient under regional anesthesia and an epidural catheter was inserted for this reason.  At the conclusion of surgery the anesthesiologist found out for the first time that the patient was fully anticoagulated before the surgery and epidural insertion, and was now at risk for an epidural hematoma. The discussion will discuss the case-management there onwards.  Full text PDF.  16. Spinal anesthetic fails due to the hyperbaric nature of 2% chloroprocaine local anesthetic. Do not repeat intrathecal chloroprocaine injections. Authors: Dr. Robert M Raw MD, Dr. ER Nwaneri MD. ABSTRACT: (case year 2010, written 2010, updated 2021) A 58-year-old male underwent ambulatory surgery to remove 2 screws from his ankle. He had previously had a fracture that was surgically repaired. It was planned for him to undergo the removal of the screws under short acting spinal anesthetic. The intrathecal 40mg of chloroprocaine failed to produce any signs of spinal block and a geberal anesthetic was subsequently used. After surgery it was discovered that he a saddle block and numb genitalia. The reasons for the failed block and the correct management thereof will be discussed.   Full text PDF.   17. Open jejunostomy created on an awake patient under coeliac plexus block and skin incision local anesthetic infiltration. Author: Dr. Robert M Raw MD ABSTRACT: (Case year 2002, written 2002, revised 2021 June) A very senile 84-year-old lady was starving to death due to a severe Zencker’s Diverticulum in her neck. She weighed 30kg. She had a fixed neck and head flexion that made routine esophageal intubation and gastrosopy impossible. In addition she had critical heart valve disease, and the Zencker’s diverticulum content would behave as if the pateint had a full stomach. The case discussion explains how her awake anesthetic was managed, the complex nerve supply of the upper abdominal viscera, and the nerve blocks that made fully awake surgery posible.    Full text PDF.  18. Insertion of a Laryngeal Airway Mask (LMA) causes a frenulum tear. Author: Dr. Robert M Raw MD ABSTRACT: (Case year 2005) (Revised 2021 June) An anesthesia trainee struggled with insertion of a laryngeal airway mask (LMA) into a pateint. After final success, oral slight bleeding was noted. After the patient awoke a torn frenulum was noted. The discussion explains how the tear accurred, and what to do to prevent frenulum tears.   Full text PDF.  19. Insertion of a Laryngeal Mask airway (LMA) causes a throat laceration. Author: Dr. Robert M Raw MD. ABSTRACT: (Case year2007) ( Written 2021-7-4) An anesthesia trainee struggled with insertion of laryngeal mask airway (LMA). After conclusion of anesthesia and surgery a bleeding laceration was discovered in the nasopharynx of the patient. The discussion explains how the tear occirred, and what to do to prevent causing such throat lacerations with LMAs.   Full text PDF. 20. A knotted perineural nerve block catheter. Author: Dr. Robert M Raw MD. ABSTRACT: (Case year 2007) (Written 2021-7-4) A trainee threaded a interscalene perineural catheterfor 10cm beyond the needle tip. That lenght of catheter beyond the needle tip was corrected to withdrawing the catheter 5cm after removal of the introducer needle. After satisfactory use of the cathter to establish and maintain a nerve block for 3o hours an attempt was made to remove the cather. Resistance to removal was felt, and an X-ray of the radio-opaque catheter revealed it was knotted. The full report will discuss the causes of knotted catheters, the dangers of knotted catheters, the management of catheters, and include an overall subject review. Full text PDF. 21. Three patients undergoing general anesthesia for surgery develop corneal abrasions or conjunctival injury. Author: Dr. Robert M Raw MD. ABSTRACT: (case years 2003-2006) (Written 2021-7-7) Three patients under differing circumstances were discovered to have painful corneal abrasions upon awakening from anesthesia after surgery. The discussion will explain how this happened, how to prevent such cases, and how to manage corneal abrasion injuries. Full text PDF. 22. A personal experience of acute local anesthetic local anesthetic tachyphylaxis. Author: Dr. Robert M Raw MD. ABSTRACT: (Case year 2007) (written 2021-7-17) An anesthesiologist had reason to inject his own one supra-orbital nerve for analgesia reasons 6-times sequentially with 0.5% bupivacaine. The duration of analgesia reduced with every repeat injection from an initial 8-hours duration to a final 2-hours duration only. This loss of drug efficacy is the phenomenon of tachphylaxis. The discussion will be full review of local anesthetic resistance, tolerance, and tachyphylaxis, all in context for general failed nerve blocks.   Full text PDF. 23.  Severe surgical emphysema and severe hypercapnia developing during laparoscopy with CO2 insufflation. Author: Dr. Robert M Raw MD  ABSTRACT: (Case year 2015) (Written 2021-7-27) A 76-year old lady underwent a laparoscopic Nissan funduplication with closure of a diaphragmatic hiatus hernia. To correct the increasing hypercarbia, her minute ventilation was progressively increased from 5.1 l/min to 13.6 l/min. Despite that her end-tidal CO2 rose to 56 mmHg and her arterial CO2 rose to over 90mmHg. She also developed subcutaneous emphysema that reached her eyes. The discussion explains these extreme changes, the reason for the very wide et- CO2 to arterial pCO2, and how she was safely managed introperatively and postoperatively. The summary presents 5 Golden rules for dealing with extreme surgical emphysema, and severe hypercapnia.  Full text PDF.   Return to page-1 of case reports.
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Case reports; page 2. 15. A patient had an epidural block placed, with catheter insertion for surgery. It was discovered after surgery that the patient had been fully anticoagulated, and was at risk for epidural hematoma.  Author: Dr. Robert M Raw MD. ABSTRACT: (case = 2003, updated 2021) A patient needed a below knee amputation for reasons of having leg ischemia. The patient was a heavy smoker with severe emphysema, and a history of an extended period of ICU lung-ventilation after a previous surgery under general anesthesia. It was decided to operate the patient under regional anesthesia and an epidural catheter was inserted for this reason.  At the conclusion of surgery the anesthesiologist found out for the first time that the patient was fully anticoagulated before the surgery and epidural insertion, and was now at risk for an epidural hematoma. The discussion will discuss the case-management there onwards.  Full text PDF.  16. Spinal anesthetic fails due to the hyperbaric nature of 2% chloroprocaine local anesthetic. Do not repeat intrathecal chloroprocaine injections. Authors: Dr. Robert M Raw MD, Dr. ER Nwaneri MD. ABSTRACT: (case year 2010, written 2010, updated 2021) A 58-year-old male underwent ambulatory surgery to remove 2 screws from his ankle. He had previously had a fracture that was surgically repaired. It was planned for him to undergo the removal of the screws under short acting spinal anesthetic. The intrathecal 40mg of chloroprocaine failed to produce any signs of spinal block and a geberal anesthetic was subsequently used. After surgery it was discovered that he a saddle block and numb genitalia. The reasons for the failed block and the correct management thereof will be discussed.   Full text PDF.   17. Open jejunostomy created on an awake patient under coeliac plexus block and skin incision local anesthetic infiltration. Author: Dr. Robert M Raw MD ABSTRACT: (Case year 2002, written 2002, revised 2021 June) A very senile 84-year-old lady was starving to death due to a severe Zencker’s Diverticulum in her neck. She weighed 30kg. She had a fixed neck and head flexion that made routine esophageal intubation and gastrosopy impossible. In addition she had critical heart valve disease, and the Zencker’s diverticulum content would behave as if the pateint had a full stomach. The case discussion explains how her awake anesthetic was managed, the complex nerve supply of the upper abdominal viscera, and the nerve blocks that made fully awake surgery posible.    Full text PDF.  18. Insertion of a Laryngeal Airway Mask (LMA) causes a frenulum tear. Author: Dr. Robert M Raw MD ABSTRACT: (Case year 2005) (Revised 2021 June) An anesthesia trainee struggled with insertion of a laryngeal airway mask (LMA) into a pateint. After final success, oral slight bleeding was noted. After the patient awoke a torn frenulum was noted. The discussion explains how the tear accurred, and what to do to prevent frenulum tears.   Full text PDF.  19. Insertion of a Laryngeal Mask airway (LMA) causes a throat laceration. Author: Dr. Robert M Raw MD. ABSTRACT: (Case year2007) ( Written 2021-7-4) An anesthesia trainee struggled with insertion of laryngeal mask airway (LMA). After conclusion of anesthesia and surgery a bleeding laceration was discovered in the nasopharynx of the patient. The discussion explains how the tear occirred, and what to do to prevent causing such throat lacerations with LMAs.   Full text PDF. 20. A knotted perineural nerve block catheter. Author: Dr. Robert M Raw MD. ABSTRACT: (Case year 2007) (Written 2021-7-4) A trainee threaded a interscalene perineural catheterfor 10cm beyond the needle tip. That lenght of catheter beyond the needle tip was corrected to withdrawing the catheter 5cm after removal of the introducer needle. After satisfactory use of the cathter to establish and maintain a nerve block for 3o hours an attempt was made to remove the cather. Resistance to removal was felt, and an X-ray of the radio-opaque catheter revealed it was knotted. The full report will discuss the causes of knotted catheters, the dangers of knotted catheters, the management of catheters, and include an overall subject review. Full text PDF. 21. Three patients undergoing general anesthesia for surgery develop corneal abrasions or conjunctival injury. Author: Dr. Robert M Raw MD. ABSTRACT: (case years 2003-2006) (Written 2021-7-7) Three patients under differing circumstances were discovered to have painful corneal abrasions upon awakening from anesthesia after surgery. The discussion will explain how this happened, how to prevent such cases, and how to manage corneal abrasion injuries. Full text PDF. 22. A personal experience of acute local anesthetic local anesthetic tachyphylaxis. Author: Dr. Robert M Raw MD. ABSTRACT: (Case year 2007) (written 2021-7-17) An anesthesiologist had reason to inject his own one supra-orbital nerve for analgesia reasons 6-times sequentially with 0.5% bupivacaine. The duration of analgesia reduced with every repeat injection from an initial 8-hours duration to a final 2-hours duration only. This loss of drug efficacy is the phenomenon of tachphylaxis. The discussion will be full review of local anesthetic resistance, tolerance, and tachyphylaxis, all in context for general failed nerve blocks.   Full text PDF. 23.  Severe surgical emphysema and severe hypercapnia developing during laparoscopy with CO2 insufflation. Author: Dr. Robert M Raw MD  ABSTRACT: (Case year 2015) (Written 2021-7-27) A 76-year old lady underwent a laparoscopic Nissan funduplication with closure of a diaphragmatic hiatus hernia. To correct the increasing hypercarbia, her minute ventilation was progressively increased from 5.1 l/min to 13.6 l/min. Despite that her end-tidal CO2 rose to 56 mmHg and her arterial CO2 rose to over 90mmHg. She also developed subcutaneous emphysema that reached her eyes. The discussion explains these extreme changes, the reason for the very wide et-CO2 to arterial pCO2, and how she was safely managed introperatively and postoperatively. The summary presents 5 Golden rules for dealing with extreme surgical emphysema, and severe hypercapnia.  Full text PDF.   Return to page-1 of case reports.
https://www.regional-anesthesia.com            Editor: Dr. Robert Maurice Raw   
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Erythroxylum coca
Case reports; page 2. 15. A patient had an epidural block placed, with catheter insertion for surgery. It was discovered after surgery that the patient had been fully anticoagulated, and was at risk for epidural hematoma.  Author: Dr. Robert M Raw MD. ABSTRACT: (case = 2003, updated 2021) A patient needed a below knee amputation for reasons of having leg ischemia. The patient was a heavy smoker with severe emphysema, and a history of an extended period of ICU lung-ventilation after a previous surgery under general anesthesia. It was decided to operate the patient under regional anesthesia and an epidural catheter was inserted for this reason.  At the conclusion of surgery the anesthesiologist found out for the first time that the patient was fully anticoagulated before the surgery and epidural insertion, and was now at risk for an epidural hematoma. The discussion will discuss the case-management there onwards.  Full text PDF.  16. Spinal anesthetic fails due to the hyperbaric nature of 2% chloroprocaine local anesthetic. Do not repeat intrathecal chloroprocaine injections. Authors: Dr. Robert M Raw MD, Dr. ER Nwaneri MD. ABSTRACT: (case year 2010, written 2010, updated 2021) A 58-year-old male underwent ambulatory surgery to remove 2 screws from his ankle. He had previously had a fracture that was surgically repaired. It was planned for him to undergo the removal of the screws under short acting spinal anesthetic. The intrathecal 40mg of chloroprocaine failed to produce any signs of spinal block and a geberal anesthetic was subsequently used. After surgery it was discovered that he a saddle block and numb genitalia. The reasons for the failed block and the correct management thereof will be discussed.   Full text PDF.   17. Open jejunostomy created on an awake patient under coeliac plexus block and skin incision local anesthetic infiltration. Author: Dr. Robert M Raw MD ABSTRACT: (Case year 2002, written 2002, revised 2021 June) A very senile 84-year-old lady was starving to death due to a severe Zencker’s Diverticulum in her neck. She weighed 30kg. She had a fixed neck and head flexion that made routine esophageal intubation and gastrosopy impossible. In addition she had critical heart valve disease, and the Zencker’s diverticulum content would behave as if the pateint had a full stomach. The case discussion explains how her awake anesthetic was managed, the complex nerve supply of the upper abdominal viscera, and the nerve blocks that made fully awake surgery posible.    Full text PDF.  18. Insertion of a Laryngeal Airway Mask (LMA) causes a frenulum tear. Author: Dr. Robert M Raw MD ABSTRACT: (Case year 2005) (Revised 2021 June) An anesthesia trainee struggled with insertion of a laryngeal airway mask (LMA) into a pateint. After final success, oral slight bleeding was noted. After the patient awoke a torn frenulum was noted. The discussion explains how the tear accurred, and what to do to prevent frenulum tears.   Full text PDF.  19. Insertion of a Laryngeal Mask airway (LMA) causes a throat laceration. Author: Dr. Robert M Raw MD. ABSTRACT: (Case year2007) ( Written 2021-7-4) An anesthesia trainee struggled with insertion of laryngeal mask airway (LMA). After conclusion of anesthesia and surgery a bleeding laceration was discovered in the nasopharynx of the patient. The discussion explains how the tear occirred, and what to do to prevent causing such throat lacerations with LMAs.   Full text PDF. 20. A knotted perineural nerve block catheter. Author: Dr. Robert M Raw MD. ABSTRACT: (Case year 2007) (Written 2021-7-4) A trainee threaded a interscalene perineural catheterfor 10cm beyond the needle tip. That lenght of catheter beyond the needle tip was corrected to withdrawing the catheter 5cm after removal of the introducer needle. After satisfactory use of the cathter to establish and maintain a nerve block for 3o hours an attempt was made to remove the cather. Resistance to removal was felt, and an X-ray of the radio-opaque catheter revealed it was knotted. The full report will discuss the causes of knotted catheters, the dangers of knotted catheters, the management of catheters, and include an overall subject review. Full text PDF. 21. Three patients undergoing general anesthesia for surgery develop corneal abrasions or conjunctival injury. Author: Dr. Robert M Raw MD. ABSTRACT: (case years 2003-2006) (Written 2021-7-7) Three patients under differing circumstances were discovered to have painful corneal abrasions upon awakening from anesthesia after surgery. The discussion will explain how this happened, how to prevent such cases, and how to manage corneal abrasion injuries. Full text PDF. 22. A personal experience of acute local anesthetic local anesthetic tachyphylaxis. Author: Dr. Robert M Raw MD. ABSTRACT: (Case year 2007) (written 2021-7-17) An anesthesiologist had reason to inject his own one supra-orbital nerve for analgesia reasons 6-times sequentially with 0.5% bupivacaine. The duration of analgesia reduced with every repeat injection from an initial 8- hours duration to a final 2-hours duration only. This loss of drug efficacy is the phenomenon of tachphylaxis. The discussion will be full review of local anesthetic resistance, tolerance, and tachyphylaxis, all in context for general failed nerve blocks.   Full text PDF. 23.  Severe surgical emphysema and severe hypercapnia developing during laparoscopy with CO2 insufflation. Author: Dr. Robert M Raw MD  ABSTRACT: (Case year 2015) (Written 2021-7-27) A 76-year old lady underwent a laparoscopic Nissan funduplication with closure of a diaphragmatic hiatus hernia. To correct the increasing hypercarbia, her minute ventilation was progressively increased from 5.1 l/min to 13.6 l/min. Despite that her end-tidal CO2 rose to 56 mmHg and her arterial CO2 rose to over 90mmHg. She also developed subcutaneous emphysema that reached her eyes. The discussion explains these extreme changes, the reason for the very wide et-CO2 to arterial pCO2, and how she was safely managed introperatively and postoperatively. The summary presents 5 Golden rules for dealing with extreme surgical emphysema, and severe hypercapnia.  Full text PDF.   Return to page-1 of case reports.
https://www.regional-anesthesia.com            Editor: Dr. Robert Maurice Raw   
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