A&A practice
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Review Case Reports
Kratom and General Anesthesia: A Case Report and Review of the Literature.
Kratom is a botanical substance derived from the Mitragyna speciosa plant, which grows naturally in Southeast Asia. Its active compounds include alkaloids with psychoactive and opioid properties. ⋯ Both the US Food and Drug Administration and the Drug Enforcement Agency warn against the use of kratom. Here is the first reported case of an anesthetic in a patient using kratom for chronic pain.
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A patient with a history of Prinzmetal angina, refractory ventricular fibrillation, cardiac arrest with an implantable cardioverter-defibrillator, and obesity presented to the emergency department at 17 weeks gestational age with a chief complaint of angina and multiple episodes of defibrillation. A T3/4 thoracic epidural was placed to assess the effectiveness of a partial chemical sympathectomy in alleviating symptoms of angina as well as decreasing the amount of defibrillation episodes. Once this proved to be beneficial in accomplishing both of these goals, a more specific approach was designed. A continuous stellate ganglion block was then placed controlling both her angina and preventing further episodes of defibrillation long enough for her pregnancy to progress beyond 24 weeks gestational age.
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Review Case Reports
Dexmedetomidine-Induced Massive Diuresis in a Patient Undergoing Spinal Fusion Surgery: A Case Report and Synthesis of the Literature.
Dexmedetomidine is an α2-adrenergic sedative-hypnotic medication used as an adjunct to general anesthesia. While experimental studies in animals have demonstrated a mild diuretic effect of dexmedetomidine, only recently have case reports described dexmedetomidine-induced diuresis in humans. ⋯ Here, we report a case of a 30-year-old woman undergoing cervical spinal fusion surgery who experienced a massive diuresis starting 30 minutes after receiving dexmedetomidine intravenous infusion. We discuss the differential diagnosis and synthesize the current literature on this rare effect.
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Myxedema coma is a rare but highly fatal condition with reported mortality >40%-50%. Early recognition and prompt treatment are critical for survival. ⋯ Consideration of the possible diagnosis of myxedema coma resulted in prompt therapy and symptom resolution within 48 hours. Thyroid disorders, although rare, should be considered in the postoperative setting.
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Airway management remains a challenge in children, and the presence of a cleft palate further complicates the scenario. Endotracheal intubation, although definitive and most preferred, may be avoided for certain short-duration procedures wherein the use of laryngeal mask airway can allow quicker emergence. We present the successful airway management of 2 pediatric patients with cleft palate undergoing ophthalmological surgery, using AMBU® LMA® as the airway device of choice, which was further used as a rescue airway device in an emergent situation of "difficult to ventilate."