A & A case reports
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Case Reports
Sciatic (Popliteal Fossa) Catheter for Pediatric Pain Management of Sickle Cell Crisis: A Case Report.
Sickle cell crisis, or vaso-occlusive crisis (VOC), is a major cause of hospitalizations for adults and children with sickle cell disease, and is associated with increased morbidity and mortality. Despite prompt pharmacological treatment and multimodal pain management, acute pain during a VOC is often not adequately controlled in the pediatric population. We placed a continuous popliteal sciatic nerve block under ultrasound guidance in a pediatric patient for localized refractory pain during a VOC, resulting in improved pain control with preserved sensorimotor function.
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Case Reports
Stepwise Rostrocaudal Brainstem Anesthesia as a Complication of Local Anesthesia: A Case Report.
Iatrogenic cranial nerve palsies can rarely complicate neurosurgical, oral maxillofacial, and otolaryngological procedures. Among the most serious complications of cranial nerve palsy is upper airway obstruction, which is life threatening. ⋯ This led to hypoxic respiratory failure requiring mechanical ventilation before resolving spontaneously. This is the first known case of accidental brainstem anesthesia secondary to lidocaine infiltration at an occipital craniectomy site and serves to caution clinicians who manage similar patients.
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Case Reports
Brachiocephalic Vein Perforation During Cannulation of Internal Jugular Vein: A Case Report.
We report a rare complication of right brachiocephalic vein perforation during ultrasound-guided cannulation of the right internal jugular vein (IJV) in a patient with a tortuous common carotid artery (CCA). We suspect that the tortuous CCA displaced the IJV, which caused misplacement of the J-tip guidewire into the subclavian vein. ⋯ This was diagnosed by videothoracoscopy. Anesthesiologists should be aware of the possibility of guidewire malposition during IJV catheterization in patients with a tortuous CCA.
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Case Reports
Use of 23.4% Saline in Symptomatic Vasospasm and Cushing's Triad to Prevent Herniation and Death: A Case Report.
A 53-year-old woman with migraines presented with Hunt-Hess grade 5 and Fisher grade 4 subarachnoid hemorrhage with intraventricular hemorrhage. She experienced severe vasospasm requiring intra-arterial medications. Continued vasospasm and edema resulted in Cushing's triad with profound tachypnea. ⋯ Despite the general practice to wait until complete neurologic deterioration before administering 23.4% saline, it was administered on 2 separate occasions, once after the failure of the 2 boluses of 3% saline and once on the reappearance of Cushing's triad 24 hours later, and on each occasion produced overall clinical improvement. The patient was subsequently discharged to a rehabilitation facility and then home. A paradigm shift to earlier intervention with 23.4% saline may improve overall outcomes in patients with severe intracranial hypertension refractory to 3% saline and impending herniation.