Journal of clinical anesthesia
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Case Reports
Horner's syndrome and trigeminal nerve palsy after lumbar epidural analgesia for labor and delivery.
This report highlights transient Horner's syndrome and trigeminal nerve palsy following labor epidural analgesia. A 29-year-old primigravida had a lumbar epidural catheter placed for analgesia in labor. ⋯ There were no other neurologic changes. Horner's syndrome and cranial nerve palsies can occur as a consequence of epidural analgesia for labor.
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A 76-year-old woman underwent double-lumen endotracheal tube intubation for right upper lobectomy. During one-lung ventilation, she developed tension pneumothorax on her dependent lung and suffered cardiac arrest. The presenting signs of tension pneumothorax--hypoxemia, hypotension, and increased airway pressure--are relatively common during this procedure, leading to a delay in diagnosis and effective treatment. When all three signs occur together during one-lung ventilation, cardiovascular collapse can result and serious consideration must be given to the diagnosis of tension pneumothorax in the dependent lung.
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Several potential complications may occur during identification of the epidural space. We present a case of subarachnoid pneumocephalus as a rare complication of epidural catheter placement.
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Comparative Study
The association of intraoperative neuraxial anesthesia on anticipated admission to the intensive care unit.
To determine whether use of intraoperative neuraxial anesthesia would decrease the frequency of ICU admission postoperatively in orthopedic patients. ⋯ Intraoperative neuraxial anesthesia in higher-risk patients undergoing elective hip or knee replacement surgery is associated with a decrease in anticipated ICU admission postoperatively. A causal relationship cannot be determined with this type of study and further research is needed to better understand this association.