A&A practice
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Dural puncture following neuraxial anesthesia can cause persistent cerebrospinal fluid leakage. A 35-year-old, 39-week gestation healthy parturient underwent cesarean delivery under spinal anesthesia. Spinal anesthesia was performed using a 25-gauge Quincke needle. ⋯ She died 3 days later. We discuss awareness of neuraxial complication among maternity staff, effective follow-up, and available management strategy in low-resource settings. Persistent headache following neuraxial anesthesia should be investigated.
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Case Reports
A Case Report of High Cervical Spinal Cord Stimulation for Chronic Otalgia and Tinnitus.
Neuromodulation continues to grow in its scope and application in the relief of chronic and debilitating disorders. Both otalgia and tinnitus can be multifactorial in etiology, with diagnostic and treatment challenges. This is a case of spinal cord stimulator placement providing a patient with near total relief of otalgia, total relief of tinnitus, and mild improvement in sensorineural hearing loss. We believe that this is the first report showing benefit of high spinal cord stimulation in tinnitus, and we consider whether there are neuronal connections between upper cervical nerve roots and the auditory pathways.
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Case Reports
Intraoperative Coronary Artery Spasm Likely Triggered by Surgical Gallbladder Manipulation: A Case Report.
Although the association between cholecystitis and acute coronary syndrome-like symptoms, including chest pain with electrocardiogram (ECG) changes, has been reported previously, it is unclear whether these symptoms can be provoked by direct stimulation to the gallbladder. We present the case of a 44-year-old man who developed coronary artery spasm (CAS) with ST-segment-elevation followed by nonsustained polymorphic ventricular tachycardia during laparoscopic cholecystectomy. The change in ECG occurred only when the gallbladder was manipulated, suggesting that direct stimulation to the gallbladder can cause CAS. Clinicians should be aware that careful ECG monitoring is necessary, especially while the gallbladder is manipulated.
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We report for the first time therapy-resistant hypernatremia (plasma sodium concentration ≥150 mmol per liter) developing in 6 of 12 critically ill coronavirus disease 2019 (COVID-19) patients age 57-84 years requiring mechanical ventilation. There was no correlation between plasma sodium concentrations and sodium input. ⋯ These findings are consistent with abnormally increased renal sodium reabsorption, possibly caused by increased angiotensin II activity secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced downregulation of angiotensin-converting enzyme 2 (ACE2) receptors. As hypernatremia was associated with increased length of intensive care unit stay, special attention should be paid to the electrolyte status of COVID-19 patients.