A&A practice
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Case Reports
Hypermetabolic Syndrome and Dyskinesia After Neurologic Surgery for Labrune Syndrome: A Case Report.
A 20-year-old man with a rare neurodegenerative disease developed hypermetabolic symptoms with dyskinesia after a third ventriculostomy for hydrocephalus. The initial presentation was concerning for an acute dystonic reaction after metoclopramide was administered for nausea. ⋯ The diagnosis was broadened to include neuroleptic malignant syndrome, serotonin syndrome, and malignant hyperthermia. Although perhaps less intellectually satisfying but more true to clinical reality, we did not isolate a single diagnosis but treated effectively all 3 with dantrolene sodium and benzodiazepine.
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The coronavirus disease 2019 (COVID-19) pandemic created an unprecedented need for mechanical ventilation in critically ill patients. To meet this increased demand, some facilities were forced to use anesthesia gas machines (AGMs) as intensive care unit (ICU) ventilators. While an off-label use, AGM manufacturers, the Anesthesia Patient Safety Foundation, and the American Society of Anesthesiologists have guidelines for AGM use in the ICU, however, there is scant literature describing their use. This article describes our experiences at New York University Langone Medical Center using AGMs in the ICU for ventilating critically ill COVID-19 patients.
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We evaluated a full-face snorkel mask with an airway circuit filter to protect health care providers against airborne pathogens. First, a quantified N95 fit test was performed using aerosolized saline. ⋯ Neither hypercapnia nor hypoxemia occurred. This modified mask has the potential to protect providers who care for patients with coronavirus disease 2019 (COVID-19).
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Propofol is a sedative and a hypnotic agent used in the induction and maintenance of general anesthesia. Propofol also relaxes skeletal muscles. ⋯ Our case report describes a 25-year-old patient with painful spastic cerebral palsy, who experienced prolonged improvement of his symptoms after treatment with propofol. The patient has received 13 administrations of propofol with similar efficacy each time.