A&A practice
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Patients presenting for major vascular surgery are often elderly, medically complex, and at increased risk for general anesthesia-related complications. A search of the published literature produced no citation regarding PECS II block in the setting of extra-anatomic bypass procedures. We present a case report describing the use of the deep injection of the PECS II block in this context. Although further investigation is needed to determine the role of truncal blocks in major vascular surgery, our case illustrates that peripheral nerve blocks, combined with continuous spinal anesthesia, may be used as an alternative to general anesthesia for axillofemoral-femoral bypass.
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Cutaneomeningospinal angiomatosis, popularly known as Cobb syndrome, is a rare clinical disorder predominantly presenting with a vascular skin lesion and a spinal angioma at the same dermatomal level. Several case reports and case series have reported on the surgical management of this syndrome, but we failed to find any information about its anesthetic considerations in the Medline database. Our case report describes the perioperative anesthetic management of a 46-year-old man with Cobb syndrome.
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In addition to cutaneous, gastrointestinal, hemodynamic, and respiratory symptoms, allergic reactions can induce an acute coronary syndrome in normal or atheromatous coronary arteries and can cause coronary stent thrombosis. Here, we report a case of coronary stent thrombosis due to allergic acute coronary syndrome during anaphylaxis induced by sugammadex in a female patient undergoing general anesthesia. She was emergently treated with percutaneous transluminal coronary balloon angioplasty with catecholamine, vasodilator, and intraaortic balloon support. Knowledge of perioperative allergy-triggered acute coronary syndrome is crucial for prompt and appropriate treatment.
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We report the anesthetic management of 2 patients with Lennox-Gastaut syndrome presenting for respective epilepsy surgery with intraoperative electrocorticography. Electrocorticography is a useful tool to guide the localization of the epileptogenic focus for surgical resection in epilepsy surgery. ⋯ We observed that dexmedetomidine-based anesthesia facilitates intraoperative electrocorticography monitoring. Dexmedetomidine, by decreasing the requirements of other anesthetic agents, offers better recovery profile and pain relief with minimal respiratory depression in patients undergoing disconnective epilepsy surgeries.
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Hereditary neuropathy with liability to pressure palsies is an autosomal dominant condition occurring in up to 16 per 100,000 people and predisposes to neural compressive injury. Given the rarity of this condition, no guidelines currently exist for the anesthetic management of hereditary neuropathy with liability to pressure palsies. We describe the management of analgesia during labor in a woman diagnosed with hereditary neuropathy with liability to pressure palsies and a history of nerve palsy after obstetric anesthesia. Our report highlights the necessity of clinician awareness of hereditary neuropathy with liability to pressure palsies and the anesthetic precautions used to successfully avoid neural injury in this case.