Interscalene block in an anesthetized adult with hypertrophic obstructive cardiomyopathy undergoing clavicle fracture reduction
Bibliographic record
Abstract
Whether regional anesthesia procedures should be performed in heavily sedated/anesthetized adults remains controversial. One of the purported advantages of performing regional nerve blocks in conversant patients is early warning against major nerve injury and, arguably, early detection of local anesthetic systemic toxicity. A 60-year-old man with hypertrophic obstructive cardiomyopathy (HOCM) underwent a clavicle fracture repair under general anesthesia. Intraoperative transesophageal echocardiography revealed dynamic left ventricular outflow track obstruction and systolic anterior motion of the posterior mitral valve leaflet. In part based on such echo findings, he received an ultrasound-guided interscalene plus a superficial cervical plexus block for postoperative analgesia prior to emergence from general anesthesia. Given the lack of robust data on the safety of ultrasound-guided regional techniques in heavily sedated/anesthetized adults, we use the example of echographic evidence of significant HOCM to argue for a pragmatic and individualized approach when faced with unusual situations in which the pros of such an approach may outweigh the cons - in this case for performing an interscalene block on an anesthetized adult.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.000 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".