A&A practice
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An elderly patient with renal cell carcinoma underwent a robotic nephrectomy. After an uneventful intraoperative period, soon after extubation she developed generalized seizures and was diagnosed with posterior reversible encephalopathy syndrome (PRES) on neuroimaging. ⋯ PRES was attributed to compromised renal function, chronic hypertension, and the effects of pneumoperitoneum. Early diagnosis, aggressive treatment, and rehabilitation are crucial for the management and recovery of patients with PRES.
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Case Reports
Digital Ischemia Secondary to Ulnar Artery Puncture Successfully Treated by Brachial Plexus Block: A Case Report.
After vascular puncture and catheterization, arteries can have many complications that impede blood flow such as vasospasm, thrombosis, and emboli generation, among other complications. Treatment depends on severity of ischemic symptoms and can range from as mild as applying local heat packs to surgical thrombectomy. We present a case of digital ischemia secondary to vascular puncture that was successfully treated with a supraclavicular nerve block, resulting in the vascular surgery team canceling an emergent surgery.
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Case Reports
Spinal Anesthesia in Elderly Patients With Femoral Neck Fractures on Apixaban Therapy: A Case Series.
This case series reviews surgeries involving elderly patients with femoral neck fractures on apixaban who underwent spinal anesthesia (SA) within 72 hours of their last dose. Despite patients being on anticoagulation, no neurological complications occurred, suggesting SA may be practical in cases where the benefits of timely surgery outweigh the potential risks, including apixaban discontinuation for a period of less than the recommended 72 hours with detectable levels of the drug remaining in the plasma. Quantitative apixaban measurements offered useful anticoagulation status insights, though safe thresholds remain undefined.
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Numerous barriers hinder the effective delivery of neurologic care as well as the education of health care professionals in the low-income and middle-income countries (LMICs). This study assessed the knowledge of the participants after Comprehensive Neurocritical Care Course (CN3C) in the LMICs. ⋯ There was improvement in their posttest scores (pretest score: 16.45 ± 5.35 vs posttest score: 24.96 ± 6.74; P < .01). The CN3C course improves the overall knowledge of neurocritical care in the participants, as evident by the posttest scores.
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We describe a patient with severe Arnold Chiari Malformation and syringomyelia who underwent gynecological laparoscopy in an emergency context; no brain imaging was available. We here report the successful use of optic nerve sheath diameter (ONSD) and middle cerebral artery (MCA) velocity measurements as surrogate monitoring for cerebral blood flow and intracranial pressure, respectively. MCA velocity was low when assessed after peritoneal insufflation and ONSD increased to 6.3 mm after Trendelenburg positioning. This noninvasive Ultrasound and Doppler neurological monitoring helped adapt the anesthetic management and the patient recovered both normal ONSD and MCA velocity values.