Anesthesia of the nail unit
Archana Singal, Shekhar Neema, Piyush Kumar in Nail Disorders, 2019
Differential diagnosis: Vasovagal response, reaction to epinephrine, and overdose of LA can mimic anaphylaxis.17Vasovagal reaction presents with diaphoresis, palpitation, nausea, bradycardia, and hypotension. Patient should be placed in the Trendelenburg position and in case of no response atropine 0.4 mg subcutaneously can be administered.Epinephrine reaction presents with palpitation, flushing, and tachycardia. Patients on propranolol can have severe reaction to epinephrine due to unopposed alpha-adrenergic activation. Epinephrine reaction resolves spontaneously and does not require any treatment. Epinephrine should be avoided in patients with uncontrolled hyperthyroidism, severe hypertension, and pheochromocytoma.Systemic toxicity resulting from overdose of LA is central nervous system (CNS) and cardiovascular (CVS) toxicity. Early features of CNS toxicity include light headedness, dizziness, tinnitus, and drowsiness. It is followed by shivering, twitching, tremors, and generalized tonic-clonic seizure. CVS toxicity is due to negative inotropic action on cardiac muscle. Bupivacaine is a more potent cardiac depressant than lignocaine. Ventricular arrhythmia can also occur resulting from intravenous administration. It is mandatory to prevent toxicity as it is very difficult to treat CVS collapse resulting from overdose of LA.
Regional anaesthesia
Daryl Dob, Griselda Cooper, Anita Holdcroft, Philip Steer, Gwyneth Lewis in Crises in Childbirth Why Mothers Survive, 2018
However, with increasing blood loss there is an increasing likelihood of the appearance of an opposing vasodepressor (vasovagal) response.20 Although the afferent receptors for this are not fully recognised in humans, the efferent response is the same as baroreceptor stimulation from high arterial pressure. Parasympathetic activation and sympathetic suppression produce ‘paradoxical’ bradycardia, vasodilation and hypotension. Vasovagal responses are seen in 50% of non-pregnant subjects after blood loss of 1000–1200 ml. Relative or absolute bradycardia in the presence of blood loss must prompt careful assessment of the circulation.
Basics of microlaryngoscopy and rigid bronchoscopy
Don Hayes, Kara D. Meister in Pediatric Bronchoscopy for Clinicians, 2023
Complications and D-dispositionComplications of rigid bronchoscopy are dependent upon multiple factors, including patient anatomy and comorbidities, indications for the procedure, clinical setting, equipment factors, anesthesia-related factors, and provider and institutional experience.The most common complications are related to the placement of rigid instrumentation and include gum/dental injury, lip pinching/lacerations, pharyngeal lacerations, laryngeal edema, and laryngospasm/bronchospasm.9Pneumothorax and barotrauma can occur if there is over-insufflation or with the use of high suction pressures with high airway pressures. A vasovagal response can also be elicited with the use of the bronchoscope; this may be more pronounced in infants < six months of age.10Rarely, direct injury to the trachea or bronchus from the telescope or bronchoscope can result in pneumothorax or subcutaneous emphysema.Cognitive failures also occur when the bronchoscopist misses or does not appreciate pathology.Following rigid bronchoscopy for diagnostic purposes, most patients can be discharged on the same day, following an observation period in the post-anesthesia care unit (disposition following therapeutic interventions can differ widely, however).
Tests for the identification of reflex syncope mechanism
Published in Expert Review of Medical Devices, 2023
Michele Brignole, Giulia Rivasi, Artur Fedorowski, Marcus Ståhlberg, Antonella Groppelli, Andrea Ungar
Identifying the mechanism of reflex syncope is the essential prerequisite for an effective personalized therapy. Indeed, the choice of appropriate therapy and its efficacy are largely determined by the mechanism of syncope rather than its etiology or clinical presentation [1]. While in most patients the etiological diagnosis of vasovagal and other forms of reflex syncope can be achieved through accurate history taking and exclusion of competitive causes, the diagnosis of the underlying mechanism requires the use of diagnostic tests aimed to document the causal link between a specific hemodynamic mechanism and loss of consciousness. The possible hemodynamic mechanisms underlying reflex syncope include hypotension and asystole/bradycardia, corresponding to two different hemodynamic phenotypes, i.e. the hypotensive and bradycardic phenotype. The choice of therapy – counteracting hypotension or bradycardia – depends on the given phenotype.
Management of pulmonary arterial hypertension during pregnancy
Published in Expert Review of Respiratory Medicine, 2023
Kaushiga Krishnathasan, Andrew Constantine, Isma Rafiq, Ana Barradas Pires, Hannah Douglas, Laura C Price, Konstantinos Dimopoulos
Several contraceptive options are available, and collaborative decision-making should be based on patient preference and clinical efficacy and safety profiles. Oral contraceptives include the combined pill and the progesterone-only pill. The latter is preferred due to the greater risk of venous and arterial thromboembolism associated with estrogen in the combined oral contraceptive pill. Progesterone is also available as a subcutaneous implant, inserted under local anesthesia [1,7,48]. Intrauterine devices such as copper and levonorgestrel-coated coils are available. Insertion of such devices is associated with a small risk of a vasovagal response, which can be pronounced in patients with PAH and therefore insertion is usually arranged in a hospital setting [3]. Barrier contraception, such as condoms and diaphragms, can protect from sexually transmitted disease but are not considered reliable forms of contraception in PAH due to contraceptive failure rates and the risk of unplanned pregnancy [1,7].
Intralesional injection of vitamin D3 versus zinc sulfate 2% in treatment of plantar warts: a comparative study
Published in Journal of Dermatological Treatment, 2021
Wafaa M. Abd El-Magid, Essam Eldein A. Nada, Reem A. Mossa
Regarding adverse effects of intralesional vitamin D3 injection, only one patient suffered from mild pain after session which resolved spontaneously within 24 h and another one suffered from hematoma. No signs of hypervitaminosis D or hypercalcemia, and no recurrence were observed. Vasovagal response remarkably attacked 40% of vitamin D3 injected patients. This response was mainly in the form of difficult breathing and coughing, and resolved spontaneously within 1–2 min. Reported side effects in previously mentioned studies included transient pain during injection, edema, erythema, and hyperpigmentation. Recurrence affected one patient in one study (19), and two patients in another study (20). No vasovagal response was reported.