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11/208. Intraoperative SSEP detection of ulnar nerve compression or ischemia in an obese patient: a unique complication associated with a specialized spinal retraction system.

    OBJECTIVE: To report a case of peripheral nerve compression caused by a specialized spinal retraction system, the Thompson-Farley retractor system, that most likely would not have been detected without intraoperative monitoring of the ulnar nerve. DESIGN: Bilateral median and peroneal nerve somatosensory evoked potentials (SSEPs) were monitored continuously during a C5 corpectomy, as was core body temperature. RESULTS: Within minutes after cervical soft-tissue retraction, the left ulnar nerve SSEP began to decline in amplitude. peroneal nerve SSEPs were normal throughout the surgery; core body temperature remained at 36 degrees /- 0.2 degrees C. After much effort to reposition the patient, the SSEPs returned to baseline and the Thompson-Farley system was replaced by a self-retracting system. CONCLUSIONS: To our knowledge, this is the first report of peripheral nerve compression caused by the Thompson-Farley retractor system. Even with careful positioning on the operating table, obese patients may be particularly at risk for upper arm compression. Continuous monitoring of SSEPs is suggested to prevent postoperative morbidity.
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12/208. Bilateral carotid body paraganglioma: case report.

    CONTEXT: Surgical treatment of carotid body paragangliomas is a challenge to the surgeon because of the large vascularization of the tumor, involvement of the carotid vessels and the close anatomical relationship with the cranial nerves. CASE REPORT: A 63-year-old patient was submitted to resection of two carotid body paraganglioma tumors found in the right-side and left-side carotid bodies at the bifurcation of the common carotid arteries. Two surgeries were performed at different times and neither of them presented any morbidity. Arteriography was fundamental for diagnosis of the small, asymptomatic tumor on the right side. DESIGN: Case Report
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13/208. Use of magnesium sulphate as adjunctive therapy for resection of phaeochromocytoma.

    The intraoperative control of cardiovascular disturbances associated with the resection of phaeochromocytoma is traditionally achieved by the use of deep anaesthesia in conjunction with alpha and beta blockers, calcium antagonists, nitroglycerine or sodium nitroprusside. We report the successful use of magnesium sulphate as adjunctive therapy in the control of the cardiovascular consequences associated with surgical resection of a phaeochromocytoma in a patient.
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ranking = 0.050694723238953
keywords = block
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14/208. Acute vasospastic attack after extradural block in a patient with Raynaud's disease.

    Implications: Raynaud's disease is an episodic and debilitating disease of the circulation to the fingers and toes. This case report describes an acute exacerbation of Raynaud's disease in a patient undergoing surgery with epidural anesthesia. This potentially hazardous complication has not been previously reported.
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keywords = block
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15/208. femoral artery ischemia during spinal scoliosis surgery detected by posterior tibial nerve somatosensory-evoked potential monitoring.

    STUDY DESIGN: A case report of unilateral leg ischemia caused by femoral artery compression detected using posterior tibial nerve somatosensory-evoked potentials during spinal scoliosis instrumentation surgery. OBJECTIVES: To report a rare cause of intraoperative unilateral loss of all posterior tibial nerve somatosensory-evoked potential waveforms. SUMMARY OF BACKGROUND DATA: Failure to obtain adequate popliteal fossa, spinal, subcortical, and cortical potentials during posterior tibial nerve somatosensory-evoked potential spinal cord monitoring usually results from technical factors or chronic conditions affecting the peripheral nerve. methods: A 16-year-old boy with thoracic scoliosis had normal posterior tibial nerve somatosensory-evoked potentials both before surgery and in the operating room immediately after anesthesia induction and prone positioning on a four-post spinal frame. RESULTS: One hour after the start of surgery, a minimal amplitude reduction of the right popliteal fossa potentials appeared. Fifteen minutes later, the amplitudes of the popliteal fossa, subcortical, and cortical potentials evoked by right posterior tibial nerve stimulation became substantially reduced. Subsequently, all waveforms were lost. Malfunction of the right posterior tibial nerve stimulator was initially suspected, but when proper function was verified, a search for other causes of this loss led to discovery of leg ischemia. The patient was repositioned on the spinal frame, and all posterior tibial nerve somatosensory-evoked potentials waveforms began to reappear 7 minutes later. There was no postoperative clinically detectable complication. CONCLUSIONS: Although technical malfunction should always be suspected when all intraoperative somatosensory-evoked potential waveforms are initially seen and subsequently lost, one should also consider the possibility that intraoperative ischemia due to limb positioning could be the etiology.
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16/208. Severe incisional pain and long thoracic nerve injury after port-access minimally invasive mitral valve surgery.

    The authors describe the occurrence of severe postoperative pain and long thoracic nerve injury after Port-Access minimally invasive mitral valve surgery. The potential for these events and the impact on postoperative hospitalization and rehabilitation are emphasized.
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17/208. Capsular block syndrome and pseudoexpulsive hemorrhage.

    Capsular block syndrome (CBS) has been recognized as a cause of immediate or delayed postoperative accumulation of fluid behind an intraocular lens/capsulorhexis complex. Hydrodissection-related rupture of the posterior capsule may be considered a variant of CBS that can manifest intraoperatively. We describe another intraoperative situation related to CBS in which fluid loculation during hydrodissection mimics a threatened expulsive hemorrhage.
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ranking = 0.25347361619476
keywords = block
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18/208. recurrent laryngeal nerve blockade in patients undergoing carotid endarterectomy under cervical plexus block.

    We report two cases of recurrent laryngeal nerve blockade arising during carotid endarterectomy under cervical plexus anaesthesia. These nerve blocks were thought to be due to the instillation of local anaesthetic. The nerve block in one patient was responsible for a paroxysm of coughing which caused the formation of a large neck haematoma. We believe this to be the first report of local anaesthetic induced recurrent laryngeal nerve blockade leading to such a complication.
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ranking = 4.9553342835995
keywords = nerve block, nerve, block
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19/208. Acute occlusion of left internal mammary artery graft during dual-chamber pacemaker implantation.

    A patient who had undergone bypass surgery 5 yr earlier, including left internal mammary artery (LIMA) grafting to the left anterior descending artery, underwent transvenous dual-chamber permanent pacemaker implantation for persistent advanced atrioventricular block. Intraoperative LIMA graft obstruction occurred, resulting in anterior myocardial infarction that was treated successfully by primary percutaneous transluminal coronary angioplasty and stenting. This is the first report of the occurrence of this complication during pacemaker implantation.
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ranking = 0.050694723238953
keywords = block
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20/208. Unintentional transfixation of a transverse cervical vein during placement of an interscalene brachial plexus catheter.

    Cervical hematoma during placement of a catheter into the interscalene groove is a known complication of the procedure. I describe the occurrence of a hematoma while using a new system that is compatible with a nerve stimulator and offers the ability to aspirate during both needle placement and catheter insertion.
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ranking = 0.1
keywords = nerve
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