Articles: postoperative.
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Case Reports
Transient C5 Sensory and Motor Blockade After a Unilateral T4 Paravertebral Block: A Case Report.
A thoracic paravertebral block (TPVB) can provide anesthesia for breast cancer surgeries. This case report describes a 58-year-old woman with a prolonged ipsilateral dense C5 dermatomal sensory and motor blockade after receiving a TPVB at T4 with 40 mL of 0.2% ropivacaine for a left total mastectomy, suggesting a high cephalad spread of anesthesia up to C5 paravertebral spaces. The lower extremities and the diaphragm were not involved. It is possible that the large volume of local anesthetic, even at low concentration, combined with her previous neural pathology and surgical laminectomy resulted in unexpected postoperative neurological changes.
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Case Reports
Anesthetic Management of a Patient With S-Adenosylhomocysteine Hydrolase Deficiency: A Case Report.
S-adenosylhomocysteine hydrolase (AHCY) deficiency is a rare congenital disorder in methionine metabolism with minimal guidelines regarding anesthetic management. This case report describes a 19-year-old man presenting for a liver biopsy in interventional radiology due to a history of elevated aminotransferases and creatine kinase. He received dextrose-containing fluids and a total intravenous anesthetic to avoid rhabdomyolysis and hyperkalemia. Anesthetic goals for patients with AHCY deficiency should focus on avoiding rhabdomyolysis, minimizing postoperative ventilatory compromise, monitoring for potential coagulopathy, and providing anxiolysis.
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Journal of neurosurgery · Apr 2022
The safety and efficacy of dexamethasone in the perioperative management of glioma patients.
In this single-institution retrospective cohort study, the authors evaluated the effect of dexamethasone on postoperative complications and overall survival in patients with glioma undergoing resection. ⋯ Combined pre- and postoperative dexamethasone use may increase the risk of postoperative wound infection, and dexamethasone use, specifically preoperative use, may negatively impact survival. These findings highlight the potential for serious negative consequences with dexamethasone use.
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Randomized Controlled Trial
Prophylactic Penehyclidine Inhalation for Prevention of Postoperative Pulmonary Complications in High-risk Patients: A Double-blind Randomized Trial.
Postoperative pulmonary complications are common. Aging and respiratory disease provoke airway hyperresponsiveness, high-risk surgery induces diaphragmatic dysfunction, and general anesthesia contributes to atelectasis and peripheral airway injury. This study therefore tested the hypothesis that inhalation of penehyclidine, a long-acting muscarinic antagonist, reduces the incidence of pulmonary complications in high-risk patients over the initial 30 postoperative days. ⋯ In high-risk patients having major upper-abdominal or noncardiac thoracic surgery, prophylactic penehyclidine inhalation reduced the incidence of pulmonary complications without provoking complications.