Journal of Clinical Anesthesia and Pain Management

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Table of Content: Volume 3, Issue 1

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Case Report Pages 79-81

Epidural Anesthesia Combined with Intravenous Dexmedetomidine Sedation for Elective Ileostomy Closure in a Patient with Bilateral Lung Transplantation: A Case Report

Authors: Jacques de Montblanc, MD, Jamil Elmawieh, MD, Camille Tilly, MD and Dan Benhamou, MD

Abstract: A patient who had undergone bilateral lung transplantation surgery four years ago and had significant residual pulmonary insufficiency was scheduled for elective ileostomy closure. The procedure was performed under epidural anesthesia, intravenous sedation with dexmedetomidine and spontaneous ventilation without tracheal intubation.

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Case Report Pages 66-69

Effectiveness of Stretching Exercises in TMJ Closed Lock Management - Case Reports

Authors: Marta Miernik and Agnieszka Nowakowska-Toporowska

Abstract: Internal derangement in temporomandibular joint (TMJ), including disc displacement without reduction with limited mouth opening, is a common TMJ disorder. The main symptoms of closed lock are limited mouth opening and pain in the affected TMJ. In such clinical cases, therapeutic management might be administered by physical therapy.

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Review Article Pages 70-78

Perioperative Challenges in Patients with Alpha-Gal Allergy

Authors: Francine J D'Ercole, MD, Vishal H Dhandha, MD, MHA, Marc L Levi, MD, April B Todd, RN and Priya A Kumar, MD

Abstract: Alpha-gal allergy, also known as, mammalian meat allergy (MMA) is well described in the Allergy literature, however, the Anesthesiology literature remains soft in supporting recommendations for perioperative management. The goal of the Centers for Disease Control and Prevention (CDC) is to better understand the pathogenesis, signs and symptoms, and prevention of this delayed anaphylactic reaction compared to the rapid onset of most food allergies, especially immunoglobulin E (IgE) mediated allergy.

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Research Article Pages 61-65

Evaluating Perioperative Blood Loss in Cardiac Surgery Patients Receiving High and Low Dose Tranexamic Acid

Authors: A Weingartshofer, MD, H Mingo, NP, B Kent, MD, SP Mackinnon, PhD and MM Kwapisz, MD

Abstract: Excessive perioperative blood loss is a concern for patients undergoing high risk procedures; thus, tranexamic acid (TXA) is administered at the beginning of surgery to minimize blood loss. Previous studies have had mixed results. The aim of this retrospective chart review is to determine whether low or high dose TXA minimizes blood transfusions and post-operative adverse events.

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Review Article Pages 53-60

Postoperative Hypertension: When Blood Pressure Cuff and Arterial Line Disagree

Authors: Olga V Storozh, MD, Muhammad A Ashraf, MD and Alan M Smeltz, MD

Abstract: Hypertension is a commonly encountered condition by anesthesiologists yet there is no clearly defined approach to monitoring and managing blood pressure in the perioperative period. In this review, we focus on common dilemmas in perioperative management of hypertensive patients including preoperative evaluation and indications for postponement of elective procedures; appraise the commonly used modes of perioperative blood pressure monitoring.

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Case Report Pages 51-52

Continuous Spinal Anesthetic in a Patient with Severe Aortic Stenosis for Total Knee Arthroplasty

Authors: Drew Jensen, MD and Adam C Young, MD

Abstract: Patients with severe aortic stenosis represent a serious perioperative challenge for anesthesiologists when presenting for orthopedic surgery. Avoiding general anesthesia can be beneficial by averting the dramatic hemodynamic changes that can occur at induction and emergence. However, regional anesthesia can similarly produce significant alterations in sympathetic tone in blocked regions. We discuss the successful use of a continuous spinal anesthetic in a patient with severe aortic stenosis undergoing elective total knee arthroplasty.

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Case Report Pages 45-50

Opioid Management and Risk Mitigation

Authors: Mark Gostine, MD, Fred N Davis and Rebecca Risko

Abstract: Over the span of seven months physicians had to reconcile two very different messages regarding pain and the use of opioids issued by institutions that guide healthcare in the United States. First, in June of 2011, The Institute of Medicine (IOM) issued a "Blueprint for Relieving Pain" in America. They rightfully pointed out that chronic pain costs the nation up to $635 billion each year in medical treatment and lost productivity. They also stated that "groups of people currently are underdiagnosed and undertreated, and the IOM encourages federal and state agencies and private organizations to accelerate the collection of data on pain incidence, prevalence, and treatments".

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