A&A practice
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This case report highlights a unique instance of spinal myoclonus after neuraxial anesthesia. It aims to inform anesthesiology providers, enhancing their ability to identify, manage, and potentially prevent similar outcomes in patients at risk.
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Spread of drugs in the epidural space may be unpredictable. The differential diagnosis of unilateral hemiparesis could be due to the unilateral spread of the drug, spinal epidural hematoma, intraspinal hematoma, and spinal cord injury. ⋯ We present a case of atypical spread of epidural local anesthetic causing hemiparesis. It emphasizes the need for careful monitoring of sensory levels on both sides and provides insight into the causes of unilateral drug spread in the epidural space.
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Case Reports
Unusual Resistance to Intravenous Anesthetic Drugs in a Rachipagus Infant: A Case Report.
In conjoined twins when one of the twins is incompletely formed and is dependent on the healthy counterpart for survival, they are described as heteropagus (parasitic) twins. Rachipagus is a type of parasitic twin joined at the spine above the sacrum. ⋯ The infant was resistant to multiple anesthetic drugs like fentanyl, propofol, and ketamine. Later general anesthesia was induced with thiopentone sodium, and the procedure went on uneventfully.
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Point-of-care ultrasound (POCUS) has established its role as a "third eye of a clinician" by virtue of its ability to provide real-time visual information. The present case highlights the role of POCUS in an 11-year-old girl with a misplaced hemodialysis catheter scheduled for surgical exploration with the removal of the catheter and direct arterial repair.
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Thoracic epidural analgesia is commonly used for postoperative analgesia for abdominal and thoracic surgeries. One complication of thoracic epidural catheter placement is a malpositioned catheter, such as in the subarachnoid, subdural, or intrapleural space. ⋯ The catheter produced a sensory level and analgesic benefit and was only identified incidentally on computed tomography (CT) imaging. This case highlights another possible anatomic location for unintentional catheter placement, which may be more common than reported, as it functioned as an epidural catheter by all clinical metrics and would not have been identified without imaging.