A&A practice
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Case Reports
Neuroleptic Malignant Syndrome Secondary to Quetiapine in Critical Care: A Case Report.
Quetiapine, an atypical antipsychotic, is widely used to treat delirium in intensive care units (ICUs). Studies demonstrate its efficacy and favorable safety profile. We report a case of an elderly patient who developed clinical and biochemical evidence of neuroleptic malignant syndrome (NMS) 5 days after quetiapine was commenced. ⋯ Quetiapine-induced NMS has occurred with long-term use in the elderly in the outpatient setting. However, NMS has not previously been reported after treatment of ICU delirium. NMS is an important complication to consider before prescribing quetiapine in the ICU.
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We report a case of Xp21 deletion syndrome, a contiguous gene syndrome associating glycerol kinase deficiency, Duchenne muscular dystrophy, and congenital adrenal hypoplasia. This results in a contraindication to the use of all halogenated agents and of propofol. ⋯ We were unfortunately unable to document the metabolic consequences of this glycerol load. We suggest that if propofol is deemed necessary in such cases, it should only be used as a bolus dose of a 2% solution.
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We present 3 cardiothoracic surgery cases during which the Drager Perseus A500 anesthesia machine and the iNOmax Delivery System were used concurrently, resulting in ventilator failures while attempting to separate from cardiopulmonary bypass (CPB). The failure was found to be caused by the iNOmax Delivery System sampling line, where negative pressure on the Perseus A500 breathing circuit precipitated a ventilator failure when the machine was brought out of "standby mode." To our knowledge, there is no discussion of this interaction in the literature, and we find this to be an important issue for patient safety during cardiothoracic surgery.