No abstract

The treatment for aortic stenosis is evolving rapidly with new developments in transcatheter aortic valve replacement (TAVR). While the procedure was initially performed under general anesthesia with invasive monitoring and transesophageal echocardiography, recent trends have shifted toward less invasive strategies. Transfemoral TAVRs are frequently performed under sedation; however, TAVRs using alternative access sites, such as the subclavian artery, are typically performed under general anesthesia. This case series describes 3 patients who underwent subclavian TAVR under combined pectoralis and interscalene blocks. All patients tolerated the procedure without complication, requiring no airway manipulation and minimal postoperative analgesia.

Background: Adolescent Long-Evans rats consume relatively high levels of an alcohol-containing liquid diet and show strong withdrawal responses after chronic alcohol consumption. Adolescent rats also show strong adaptive responses to chronic caffeine. Methods: The present study has used this model to investigate caffeine-alcohol co-use with caffeine administered to adolescent rats with and before an alcohol-containing liquid diet. There were four age-matched treatment groups (minimum of 12 rats per group): alcohol alone, alcohol administered with caffeine, caffeine administered before alcohol and caffeine, and caffeine administered before alcohol alone. Subsequent alcohol withdrawal severity was scored on a 4-point scale. Results: Followed through 3 weeks of co-administration, the presence of caffeine with alcohol in the liquid diet had no effect on the severity of subsequent alcohol withdrawal symptoms. After one week of alcohol consumption, withdrawal severity was modest, but it increased significantly by weeks 2 and 3. The same pattern was recorded for rats that were co-administered caffeine with alcohol. In contrast, administration of caffeine before the alcohol-containing diet significantly reduced the severity of alcohol withdrawal. Evidence of adaptive changes to the chronic caffeine pretreatment came in the form of decreased motor behavior during caffeine withdrawal and tolerance to the motor-activating effects of caffeine challenge. Caffeine pretreatment was effective only if caffeine was also included with alcohol in the liquid diet. Conclusion: The results present a pattern of caffeine consumption that can influence adolescent alcohol withdrawal severity and potentially mask this physical symptom of alcohol dependency.