A&A practice
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Obstructive hydrocephalus caused by brainstem compression is a life-threatening complication and usually occurs within 6 days, with peak on day 3 after onset of cerebellar infarction. We present a case of obstructive hydrocephalus that developed on day 8 in a patient with cerebellar infarction. ⋯ He was lucid postoperatively, but his consciousness was diminished on day 8 because of obstructive hydrocephalus. Cerebral edema due to cardiopulmonary bypass may contribute to delayed onset of obstructive hydrocephalus, especially in patients with large-sized cerebellar infarction.
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We report the management of a parturient with undiagnosed hypokalemic periodic paralysis (HOKPP) who underwent epidural analgesia for labor, complicated by an unintentional dural puncture, and the eventual use of epidural anesthesia for cesarean delivery. Following discharge, she represented with lower extremity paresis. After being evaluated for a compressive neuraxial lesion, she made a full recovery following potassium repletion. The obstetric anesthetic implications for patients with HOKPP and how this disorder impacts the evaluation of acute motor weakness in the immediate postpartum period in a patient who recently received a neuraxial procedure are discussed.
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A patient with ankylosing spondylitis in a "can't intubate, can't oxygenate" situation was rescued with cannula cricothyrotomy and transtracheal jet oxygenation. The case revealed clinical and systematic weaknesses, leading to standardization and reorganization of our equipment. ⋯ Cognitive aids specific to emergency front-of-neck access (eFONA) were created and placed strategically with the eFONA equipment to prompt and guide operators during airway emergencies. The aids have also been incorporated into our training curriculum to encourage their use.
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Case Reports
Use of Continuous Glucose Monitoring to Facilitate Perioperative Glycemic Management: A Case Report.
Perioperative glycemic management remains an important variable in a host of postoperative outcomes, including wound infection, reoperation, and death. Patients with diabetes mellitus are increasingly utilizing continuous glucose monitors to assist with glycemic management; the ability to harness the intensive monitoring capabilities of continuous glucose monitoring (CGM) technology perioperatively presents a promising opportunity to improve patient outcomes. Here, we assessed the accuracy of CGM compared to capillary point-of-care and arterial blood analysis in 2 cases where CGM was utilized as an adjunct method of perioperative glucose monitoring.
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Following the placement of lumbar plexus and parasacral sciatic catheters for complex lower extremity surgery, a 19-kg child had dense sensory and motor blockades in the postanesthesia care unit. The surgical team felt obligated to exclude anatomically modifiable compression of the sciatic nerve and planned for surgical reexploration. Using an insulated short, beveled needle, direct electrical nerve stimulation distal to the parasacral sciatic block and proximal to the surgical site elicited tibial nerve motor function and confirmed nerve integrity. Peripheral nerve stimulation can be used to differentiate between the etiologies of motor blockade in time-critical situations.