A & A case reports
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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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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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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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Patients with glutaric aciduria type I are at risk for acute striatal injury precipitated by catabolic stress. Here, we report the successful interdisciplinary anesthetic and perioperative management of a child with glutaric aciduria type I undergoing cardiac surgery with extracorporeal circulation. Given the central focus on prevention of acute striatal injury, our anesthetic strategy emphasized avoiding a high protein load, high-dose inotropics, especially epinephrine (associated with impaired glucose utilization), deliberate hyperventilation, and other interventions associated with systemic inflammatory response.