A&A practice
-
A parturient with unknown thrombotic thrombocytopenic purpura (TTP) received spinal anesthesia for cesarean delivery with subsequent discovery of a platelet count of 7000 × 10/L. Neurologic recovery was normal. ⋯ There is reporting bias in the literature toward cases in which severely thrombocytopenic patients sustain complications after regional anesthesia. It is important to report all cases of neuraxial anesthesia in severely thrombocytopenic patients, including those such as ours, wherein patients recover normally.
-
Case Reports
Fatal Clostridium perfringens Meningitis Following Caudal Anesthesia in an Infant: A Case Report.
Caudal anesthesia is referred to as a simple and safe method to obtain analgesia in infants during various surgical procedures. Here, we present a fatal course of a premature infant that received caudal anesthesia for inguinal hernia repair. ⋯ The infant died 17 days after surgery. Preoperative screening for C. perfringens and particular caution in infants with intracerebral hemorrhages are discussed as potential factors to be considered when anesthesia is planned.
-
Awake endotracheal intubation is the technique of choice to secure the airway when both mask ventilation and intubation are anticipated to be difficult. We present a case of a patient with a known difficult airway, bronchopleural fistula (BPF), and acute respiratory distress syndrome (ARDS) who was intubated with a double-lumen endotracheal tube (DL ETT) under awake condition using a videolaryngoscope. ⋯ The patient was treated successfully for ARDS and discharged home. To our knowledge, this is the first reported case of successful videolaryngoscope-assisted DL ETT intubation in an awake patient.
-
We present the case of a patient with a subcutaneous implantable cardioverter-defibrillator (S-ICD) in situ. Device interrogation and reprogramming were unsuccessful due to a software mismatch between the device and programmer. ⋯ The S-ICD has unique perioperative considerations for the anesthesiologist. This case provides an example of the complexity of electrophysiologic devices in current use and the necessity of the anesthesia provider to stay up to date with evolving device management strategies.
-
A 65-year-old man undergoing posterior cervical decompression and fusion demonstrated absent lower extremity evoked potential (EP) after prone positioning and before incision. Localized EP change pointed to either a technical or positional culprit. ⋯ During the test, we observed both symmetrical and asymmetrical hemispheric changes in density spectral array β and γ bands that correlated with awakening, eye-opening, and extremity movements. By providing real-time information on brain state, processed electroencephalogram (EEG) can facilitate a safe wake-up test by showing high-power β and γ activities that precede awakening.