A&A practice
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A 62-year-old male patient presented for cataract surgery under retrobulbar block anesthesia. After the regional block, the patient exhibited sudden onset and progressive symptoms of nausea, vomiting, central-type vertigo, and hearing loss. ⋯ This report demonstrates a combination of auditory and vertiginous symptoms after a retrobulbar block. It emphasizes continuous care and vigilance when using regional anesthesia due to the potential risks and varied complications.
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Remimazolam is a new ultrashort-acting benzodiazepine sedative, the use of which has not been reported for pediatric cardiac surgery. This case report describes the use of remimazolam in a 6-year-old girl who underwent minimally invasive cardiac surgery with right-sided thoracotomy for an atrial septal defect. ⋯ The patient awoke and was extubated promptly after surgery, without any serious adverse events, including intraoperative awareness. Remimazolam may be a viable option for general anesthesia during pediatric cardiac surgery.
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Case Reports
Intraoperative Diagnosis of Bilateral Upper Limb Arteriovenous Fistulae in a Child: A Case Report.
Arteriovenous fistulae have not been extensively reported in pediatric patients and are rare for pediatric anesthesiologists to encounter in their routine practice. Awareness of these lesions enables clinicians to avoid giving medications through the anomalous vascular connections. We report a child scheduled for an excision of a sacrococcygeal mass in whom we incidentally diagnosed the presence of arteriovenous fistulae in both his upper limbs. The affected limbs should be avoided and the vessels of the lower limbs should be cannulated for administration of fluid and medications during surgery.
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We present a case of a 12-year-old female with a history of infantile spasms who developed a propofol-associated acute dystonic reaction after emergence from general anesthesia for foot surgery. Uniquely, the patient's postoperative symptoms of an acute dystonic reaction were refractory to standard treatment with anticholinergics but were successfully treated with corticosteroids. The absence of any dystonic symptoms following subsequent foot surgery under general anesthesia without propofol supported a propofol-associated etiology. This case may contribute to a better understanding of the underlying mechanisms of propofol-associated acute dystonic reactions and adds a possible new treatment option.
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A 39-year-old woman with juvenile idiopathic arthritis complicated by nonuremic calciphylaxis presented for pain management of bilateral lower extremity wounds requiring frequent dressing changes. Bilateral single-shot femoral nerve blocks using liposomal bupivacaine and 0.25% bupivacaine were performed. ⋯ Repeat, bilateral single-shot femoral nerve blocks with liposomal bupivacaine and 0.25% bupivacaine were performed approximately every 72 hours to maintain adequate analgesia. We conclude that off-label use of liposomal bupivacaine in femoral nerve blocks results in prolonged block duration without adverse effects or tachyphylaxis.