A & A case reports
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I report the occurrence of left arytenoid dislocation in 2 patients undergoing laparoscopic surgical procedures formerly used only for weight loss and that are now being used for treatment of diabetes. After uncomplicated tracheal intubation, a calibrating orogastric tube was inserted into the esophagus blindly and without difficulty. ⋯ I suspect that the insertion of the calibrating orogastric tube in these nonobese patients may have led to the development of this rare complication. Recognition of its occurrence and subsequent treatment are important to preventing long-term consequences of arytenoid dislocation.
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Impetigo herpetiformis (IH), or generalized pustular psoriasis of pregnancy, is an exceedingly rare, generalized pustular skin eruption occurring during pregnancy associated with hypovolemia, sepsis, hypocalcemia, and airway edema. Fetal outcomes are generally poor, and parturients with IH may present with emergent indications for cesarean delivery due to placental insufficiency. We present a case of IH in a 19-year-old G1P0 who underwent successful general anesthesia for cesarean delivery. Her case highlights the anesthetic implications for patients afflicted with this rare disease, including perioperative pain management, airway concerns, considerations for neuraxial anesthesia, and monitoring challenges.
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Reports of acute onset of Guillain-Barré syndrome (GBS) after epidural anesthesia/analgesia after labor and cesarean delivery has raised concern of a correlation between GBS and the use of neuraxial anesthesia. We present a patient who developed bilateral lower extremity weakness and paraparesis within hours after removal of an epidural catheter for cesarean delivery. The clinical diagnosis was highly suggestive for GBS after magnetic resonance imaging, cerebrospinal fluid findings, electromyogram, and nerve conduction studies. We discuss the pathophysiological mechanisms suggested in previous case reports and describe the relationship between epidural analgesia and GBS.
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Hair loss after surgery has many causes. If the onset is acute and it lasts for several months, it is often attributed to telogen effluvium. A case is presented where hair loss occurred after a surgical procedure, but it did not recur after a subsequent procedure with a similar anesthetic.
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Occurrence of severe hypotension after indocyanine green injection during the intraoperative period.
Indocyanine green (ICG) is generally considered to be safe for IV administration and has a very low incidence of complications. We report 2 cases of severe hypotension immediately after low dose administration of IV ICG. ⋯ Anesthesiologists and surgeons are increasingly likely to encounter or request the intraoperative administration of ICG, and they need to be aware of this potential for an adverse reaction, particularly with the repeated doses. Anesthesia and other intraoperative conditions may mask the typically mild adverse reactions usually associated with ICG.