The ACS was first described in surgical patients with abdominal trauma, bleeding, or infection, but in recent years ACS has also been described in patients with other pathologies such as burn injury and sepsis. Some of these so-called nonsurgical patients will require surgery to treat their ACS. This review article is intended to provide surgeons with a clear insight into the current state of knowledge regarding IAH, ACS, and the impact of IAP on the critically ill patient.
IntroductionCervical epidural corticosteroid injections are frequently used for the treatment of subacute cervicobrachial pain. This therapy is considered safe, with the vast majority of the complications being minor and transient.Case ReportWe present a case of a woman in her fifties who suffered from cervicobrachialgia and received 2 cervical epidural corticosteroid infiltrations. On day 3 after the second infiltration, a new headache appeared and on day 16 a bilateral subdural hematoma was visualized on CT scan. Complete resorption of the hematoma was seen on day 25 without surgical intervention.DiscussionUp until now, only 1 case report of an intracranial subdural hematoma after a cervical epidural steroid injection has been published. But several cases of an intracranial subdural hematoma after spinal, epidural, or combined spinal and epidural anesthesia have been reported. Physicians should be aware of this potentially dramatic complication since post‐dural puncture headache after any type of procedure can evolve into a subdural hematoma. Clinical differentiation between the two can be difficult; post‐dural puncture headache is characterized by relief of symptoms in the supine position and photophobia/phonophobia. A subdural hematoma should be considered if the headache changes in character, does not respond to treatment, or there are neurological signs such as nausea/vomiting and blurred vision. Immediate medical imaging should then be performed.
Transesophageal echocardiography (TEE) has become a useful intraoperative tool for the cardiac anesthesiologist; however, it continues to extend its utility to noncardiac surgery as well. Hemodynamic instability, cardiac tamponade, and aortic dissection among others are readily diagnosed with TEE, providing an opportunity for prompt treatment. Many anesthesiologists, as well as intensivists and cardiac surgeons, seek proficiency with TEE in preparation for the National Board of Echocardiography's Perioperative Transesophageal Echocardiography examination and certification. Savage et al have developed a self-assessment DVD that in conjunction with a standard TEE textbook provides an excellent background for TEE competency and certification.The DVD, Interactive TEE Review: Self-Assessment Examination (Lippincott Williams & Wilkins, released October 1, 2007), is a fantastic supplement to a comprehensive TEE textbook for reviewing key principles and common pathologies. The review is divided into study and test modes, allowing for direct feedback or a video-based examination. Approximately 400 questions are used covering 31 chapters with topics including physics of ultrasound, surgical anatomy, assessment of valvular function, and organization of a TEE service, among others.Once the study or test mode is selected, easy-to-navigate menus allow the selection of any or all of the various chapters for review as well as the number of questions desired. The basic format provides a stem question in the top left with multiple-choice answers below. If a TEE loop or still image is involved, it is displayed conveniently on the right with the ability to enlarge to a full view for closer review. When in study mode, correctness and explanations are provided upon answer selection, whereas test mode provides a summary with opportunity for similar explanations upon examination completion. The 2 modes combined provide an opportunity to the echocardiographer for review and self-assessment within the same 31 essential chapters.The review provides an excellent variety of questions with superb image-quality video loops; however, future versions of the review may benefit from an increase in the volume of questions. Although the explanations to questions are mostly sufficient, another potential addition to further complete the review DVD may include references to standard TEE texts so that the trainee may further investigate areas of deficiency.This new interactive TEE review DVD offers a splendid coverage of echocardiography to both the established and training anesthesiologists within the cardiac and noncardiac realms. Savage et al are applauded for their work in creating a well-designed, easy-to-navigate, educational TEE resource. Intraoperative Echocardiographic Detection of an Anomalous Left Main Coronary ArteryTo the Editor:A nonsmoking 40-year-old man presented for elective coronary angiography because of atypical precordial pain in conjunction with dyspnea during heavy exercise for a duration of 3 months. The coronary angiography r...
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