Journal of clinical anesthesia
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Transient Global Amnesia (TGA) is short-term inability to form new memories despite otherwise normal neurological function. There is associated anterograde and retrograde amnesia. The memory loss is often accompanied by repetitive questioning and temporal disorientation while higher cognitive functions are preserved. The symptoms usually resolve by 24h. ⋯ TGA presents dramatically, it needs to be differentiated from cerebral event. It resolves on its own. But one needs to be aware of existence of such an entity.
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A 75-year-old man presented with dizziness and fatigue secondary to ventricular and supraventricular arrhythmias. He underwent an elective ablation but continued to suffer from ventricular tachycardia with cardiovascular instability despite antiarrhythmic therapy with multiple agents. The patient continued to develop episodes of ventricular tachycardia and an episode of ventricular fibrillation. ⋯ The patient demonstrated sinus rhythm with episodes of sinus tachycardia. Left stellate ganglion block has proven to be a successful mode of treatment for those patients with ventricular tachyarrhythmia resistant to medical management or those who fail atrioventricular node ablation. Ultrasound-guided left stellate ganglion block is a valuable and effective means to providing sympathectomy in the management of electrical storm or ventricular tachyarrhythmias.
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We describe the first case of severe hypernatremia associated to laparoscopic surgery for hydatid cyst in an adult patient after the use of hypertonic saline solution with complete resolution. Severe hypernatremia is an unusual fact at the immediate postoperative period but may have fatal consequences for the patient and need immediate action. ⋯ The relation between this surgical technique and the severe complication is discussed. More experience is needed in terms of safety for the patient.
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Case Reports
Partial displacement of epidural catheter after patient position change: A case report.
Epidural catheter migration is a well-known cause of failed anesthesia and complications. One of the factors that affect catheter movement is when patients change their position after skin fixation. We report a case of an epidural catheter placed without evidence of intravascular or subdural insertion that produced an insufficient block. ⋯ The planned operation was completed without a pneumatic tourniquet. A postoperative C-arm fluoroscopic image revealed that 1 side hole of the catheter had moved out of the epidural space. We think that a positional change after catheter fixation was the reason for catheter outmigration leading to insufficient analgesia, which was incompatible with the amount of local anesthetic injected.
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Case Reports
Use of test dose allows early detection of subdural local anesthetic injection with lumbar plexus block.
A 56year-old woman underwent a lumbar plexus block for a revision of a left total hip arthroplasty. During the block procedure, the needle was advanced over the transverse process and isolated quadriceps twitches were elicited. After administering a test dose of 3ml of 1.5% lidocaine, the patient developed loss of sensation in the L3-4 dermatomal distribution that progressed caudally to involve both legs followed by inability to move the left leg. ⋯ The patient was resuscitated with normalization of blood pressure and eventually had full resolution of motor and sensory block. Subdural spread of local anesthetic is a potential complication of lumbar plexus block related perhaps to injection of local anesthetic near dural sleeves of nerve roots. The use of a test dose allows early recognition of subdural injection and may limit consequences of inadvertent subdural spread of local anesthetic.