A&A practice
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Complex regional pain syndrome (CRPS) can be a debilitating, persistent, and treatment-resistant pain condition. This report presents a case of severe CRPS affecting multiple limbs, resistant to standard treatment modalities. Treatment with spinal cord stimulation (SCS) had an initial good effect. ⋯ A lead fracture resulted in a rapidly developing recurrence of CRPS in the patient's arm, necessitating amputation. SCS may be an effective modality for treatment of severe CRPS. However, mechanical problems should always be considered when an SCS-implanted patient experiences rapid symptom progression or abrupt cessation of stimulation.
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Case Reports
Hypermetabolic Syndrome and Dyskinesia After Neurologic Surgery for Labrune Syndrome: A Case Report.
A 20-year-old man with a rare neurodegenerative disease developed hypermetabolic symptoms with dyskinesia after a third ventriculostomy for hydrocephalus. The initial presentation was concerning for an acute dystonic reaction after metoclopramide was administered for nausea. ⋯ The diagnosis was broadened to include neuroleptic malignant syndrome, serotonin syndrome, and malignant hyperthermia. Although perhaps less intellectually satisfying but more true to clinical reality, we did not isolate a single diagnosis but treated effectively all 3 with dantrolene sodium and benzodiazepine.
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The relatively high cost of sugammadex compared to neostigmine limits its widespread use to reverse neuromuscular blockade, despite its faster onset and more complete clinical effect. While ensuring timely access to sugammadex is important in improving perioperative safety, it is also vital to control unnecessary spending. ⋯ Monthly spending on sugammadex decreased by 52% ($70,777 vs $33,821), while medication access increased via automated medication dispensers in each operating room. Clinical usage decreased by one-third, with presumed increased adherence to dosing guidelines.
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Case Reports
Anesthesia Management for Pediatric Patient With Multiple Endocrine Neoplasia Type 2B: A Case Report.
Administering anesthesia to patients with pheochromocytoma may cause an exacerbation of catecholamine secretion from the pheochromocytoma secondary to drug administration, stress, or manipulation of the tumor. We present a pediatric patient with undiagnosed multiple endocrine neoplasia type 2B (pheochromocytoma, thyroid carcinoma, and mucosal neuromas), initially diagnosed and treated for postviral myocarditis and cardiomyopathy, who presented for abdominal magnetic resonance imaging (MRI) under general anesthesia. Untreated cardiomyopathy poses an extra anesthesia mortality risk for patients with pheochromocytoma usually due to myocardial failure, myocardial infarction, or hypertensive hemorrhage into the myocardium or brain.
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Airway exchange catheter is a valuable tool where an airway is anticipated to be difficult to reintubate. We report a case of subcutaneous emphysema, pneumomediastinum, pneumoperitoneum, and pneumothorax after extubation using an exchange catheter. ⋯ The patient was ventilated for 2 days and then extubated without complications. Airway exchange catheter should be used cautiously with a low initial gas flow during extubation.