A&A practice
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Currarino triad is a rare hereditary condition characterized by anorectal malformation, sacral dysgenesis, and a presacral mass. Neuraxial anesthetic techniques pose increased risks to patients with spinal malformations. ⋯ We present the case of a parturient with Currarino triad and a low conus medullaris undergoing cesarean delivery where preprocedural magnetic resonance imaging and ultrasound imaging allowed for successful combined spinal-epidural anesthesia to be performed. Despite these measures, however, the patient did develop a high spinal and temporary postoperative dizziness.
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Case Reports
Postoperative Acute Angle-Closure Glaucoma: A Rare but Serious Complication: A Case Report.
Acute angle-closure glaucoma is a rare complication of general anesthesia. If not treated in time, acute angle-closure glaucoma can potentially cause permanent loss of vision. Physicians should therefore be vigilant for the possibility of acute angle-closure glaucoma in patients who experience postoperative change or loss of vision. ⋯ This report begins by examining a case of unilateral acute angle-closure glaucoma. The potential triggers of this complication are discussed. This article concludes with a flowchart to aid anesthesiologists to accurately diagnose postoperative ophthalmic pathology.
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Cerebrovascular events, along with the early presentation of central pain, during pregnancy, are uncommon. We report a case of a parturient with intense central poststroke pain after an ischemic cerebrovascular incident at 15 weeks of gestation, attributed to cerebral venous thrombosis. After a multidisciplinary team consultation, she was scheduled for cesarean delivery at 35 weeks of gestation, under combined spinal-epidural anesthesia. Due to severe left-sided neurological deficits and ipsilateral intense neuropathic pain, the neuraxial technique was successfully performed using the paramedian approach.
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Three patients underwent laryngeal and tracheal surgeries under apneic conditions using transnasal humidified rapid-insufflation ventilatory exchange. Transcutaneous carbon dioxide (CO2) levels were recorded throughout the apneic period to detect rates of CO2 rise. ⋯ The average rate of transcutaneous CO2 rise (1.7 mm Hg/min) was higher than previously reported using this technique. This suggests a need for further investigation into the utility of transnasal humidified rapid-insufflation ventilatory exchange for airway surgery and adequate ventilation during apnea.
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Case Reports
A Case Report of Paravertebral Block: A Safe Alternative for Microdiscectomy in a Pregnant Patient.
Nonobstetric surgery during pregnancy is common. Administration of safe anesthesia to a pregnant patient, while minimizing its side effects on the fetus, is a major challenge for the anesthesiologist. ⋯ Regional nerve blocks are being explored as possible alternatives whenever feasible. This report emphasizes the usefulness of ultrasound-guided, modified bilateral paravertebral block in a first-trimester pregnant patient undergoing microdiscectomy for cauda equina syndrome.