A & A case reports
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Pneumocephalus may occur after inadvertent injection of air into the subarachnoid space while performing epidural anesthesia using a loss-of-resistance technique with air in the syringe. We report a case of pneumocephalus after an interlaminar epidural steroid injection using the loss-of-resistance to air technique. In this report, we examine the etiology, the expected course of symptoms, and resolution, as well as treatment, of pneumocephalus following a systematic literature review.
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A 44-year-old woman presented for sentinel node biopsy and segmental mastectomy. After anesthetic induction, a laryngeal mask airway was placed, and ventilation was satisfactory. Three minutes after isosulfan blue dye injection, ventilation became difficult. ⋯ Twenty minutes later, she became hypotensive and unresponsive to phenylephrine, ephedrine, and vasopressin. With erythema and swelling in her arm and chest, low-dose epinephrine was titrated until her mean arterial blood pressure stabilized. Serum tryptase was increased to 27.2 μg/L (normal 0.4-10.9 μg/L).
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Fibrodysplasia ossificans progressiva, a rare and severely disabling genetic condition, is characterized clinically by progressive ossification of skeletal muscle and connective tissue and congenital malformations of the great toes. Recurrent episodes of heterotopic ossification (flare-ups) lead to increasing loss of mobility as joints become progressively affected. We report the case of a young woman with fibrodysplasia ossificans progressiva who had recurrent, debilitating myoclonus that was refractory to conventional therapies but was relieved for prolonged periods after general anesthesia was administered.
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Various equipment malfunctions of anesthesia gas delivery systems have been previously reported. Our profession increasingly uses technology as a means to prevent these errors. We report a case of a near-total anesthesia circuit obstruction that went undetected before the induction of anesthesia despite the use of automated machine check technology. This case highlights that automated machine check modules can fail to detect severe equipment failure and demonstrates how, even in this era of expanding technology, manual checks still remain essential components of safe care.