Background: Residual neuromuscular blockade (RNMB) is a frequent event after general anesthesia, which can lead to serious complications, such as upper airway obstruction. Sugammadex is useful in reversing RNMB. However, its use in infants has not yet been approved by the Food and Drug Administration. Therefore, anesthesiologists can be hesitant use it, even in situations where no other choice is available.Case: A two-month-old baby presented to the hospital for umbilical polypectomy. At the end of the surgery, neostigmine was administered. Even after waiting for 30 min and injecting an additional dose of neostigmine, neuromuscular blockade was not adequately reversed. Eventually, sugammadex was administered, and spontaneous breathing returned.Conclusions: If there were no particular causes of delayed return to spontaneous breathing in infants, RNMB should be considered and reversal with sugammadex would be useful.
Background: Pleurisy is an inflammation of the parietal pleura and is characterized by pleuritic pain. The most common cause of pleurisy is infection; other causes include rheumatoid arthritis, malignancy, rib fractures, or trauma. Possible causes of chest pain associated with golf include costochondritis, stress fractures of the ribs, intercostal muscle strain, or, rarely, Tietze’s syndrome and slipping rib syndrome.Case: A 64-year-old female presented with intractable chest pain that began 4 months prior while playing golf. No specific cause was found after various examinations. There was persistent pain despite medical treatment. Ultrasonography (US) was performed over the painful areas, which revealed focal pleural effusions. A mixture of ropivacaine and triamcinolone was injected into the focal pleural effusions using US guidance, which dramatically relieved her pain.Conclusions: This case demonstrates that US can be used as a diagnostic and therapeutic modality for intractable chest pain with an undetected pathology.
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