A&A practice
-
A 42-year-old woman with diabetes mellitus type 2 treated with the sodium-glucose cotransporter-2 inhibitor canagliflozin underwent elective bariatric gastric bypass. The canagliflozin was held for 24 hours preoperatively. ⋯ This diagnosis was challenging to make as the patient never became hyperglycemic. We use this case to discuss the pharmacology and potential risk of perioperative sodium glucose cotransporter-2 inhibitor administration and to advocate for revision of current guidelines regarding the perioperative management of these agents.
-
Case Reports
Perioperative Management of a Child With Glucose Transporter Type 1 Deficiency Syndrome: A Case Report.
Glucose transporter type 1 deficiency syndrome (GLUT1DS) causes central nervous system dysfunction including intractable epilepsy caused by impaired glucose transport to the brain. To prevent convulsions and maintain an energy source for the brain in patients with GLUT1DS, the maintenance of adequate ketone body concentrations, compensation of metabolic acidosis, and reduction of surgical stress are essential. We here report the perioperative management of a child with GLUT1DS.
-
The perioperative implementation of continuous peripheral nerve blocks is poorly described within the literature for replantation surgeries beyond digital replantation. The management of replantation patients presents a challenging balance between pain control and limb perfusion. We report the successful use of a continuous interscalene catheter in a therapeutically anticoagulated patient after midshaft humerus arm replantation. The benefits of the continuous peripheral nerve block for the patient included improved pain control and potentially improved limb perfusion making it a valuable component of this patient's treatment.
-
Correction of profound hyponatremia requires careful planning and close monitoring to reduce the risks of neurologic injury. Although there are various suggested treatment strategies in the setting of a medical ward or intensive care unit, reports of intraoperative management to prevent rapid increases in serum sodium are lacking. We present a case of profound hyponatremia of 102 mmol/L in a patient who required emergent operative repair for bowel obstruction. This is the first case to our knowledge that demonstrates a perioperative fluid and desmopressin treatment strategy to prevent overly rapid changes of sodium concentration in a patient with severe hyponatremia.
-
Case Reports
Transcutaneous Electrical Nerve Stimulation in Treatment of Occipital Neuralgia: A Case Report.
Occipital neuralgia is the third most common headache syndrome after migraine and tension type headaches. There is no well-established treatment regimen for a reliable cure. The current case presents a 39-year-old woman, diagnosed with occipital neuralgia of idiopathic cause. ⋯ The patient was started on conventional transcutaneous electrical nerve stimulation, 3 sessions per week. After the procedure, the patient achieved significant pain relief: 1-2/10 on the numeric rating scale, pain initially being 10/10. With maintenance therapy consisting of physical therapy, deep tissue massage, and muscle relaxants, 12 months after starting transcutaneous electrical nerve stimulation therapy, she is pain free.