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Outbreak of fungal meningitis associated with epidural anesthesia (June 2023)
In May 2023, an outbreak of fungal meningitis was reported in the United States among patients who had cosmetic procedures under epidural anesthesia in the city of Matamoros, Tamaulipas, Mexico. The causative agent was identified as Fusarium solani species complex. As of June 14, 2023, 18 suspected, 10 probable, and six confirmed cases have been reported; four of these patients died. Persons who received epidural anesthesia at River Side Surgical Center or Clinica K-3 since January 2023 should be evaluated for meningitis, regardless of symptoms. Empiric therapy with liposomal amphotericin B plus voriconazole should be initiated in those with a cerebrospinal fluid (CSF) pleocytosis. Updated information on this outbreak can be found on the CDC website.
Multimodal strategies to manage pain after thoracotomy (June 2023)
The Society of Cardiovascular Anesthesiologists has a new practice advisory on pain management of thoracic surgical patients, a group that typically has moderate-to-severe postoperative pain. Effective postoperative pain control promotes recovery by allowing early mobilization, reducing risk for pulmonary complications, and potentially preventing development of persistent pain. The advisory emphasized using customized multimodal opioid-sparing strategies, such as combinations of neuraxial analgesia, regional nerve blocks, and nonopioid analgesics to control postoperative pain. We agree with this guidance.