A&A practice
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Electroconvulsive therapy (ECT) in a patient with an implantable cardioverter-defibrillator (ICD) presents challenges to anesthesiologists. We encountered a patient who received an inappropriate shock during ECT despite magnet application. The phenomenon provides insight into how ICDs work-how they can inappropriately detect ECT stimulation and how they deliver antitachycardia therapy. We illuminate issues related to using magnets, discuss risks associated with inappropriate ICD therapy, and provide guidance for ICD management during ECT.
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Case Reports
Anesthetic Management of Reversible Cerebral Vasoconstriction Syndrome During Vaginal Delivery: A Case Report.
Reversible cerebral vasoconstriction syndrome (RCVS) is a rare group of vascular disorders characterized by severe headache with or without other neurologic symptoms. Pregnancy is known to precipitate RCVS, typically in the postpartum period. ⋯ Labor and vaginal delivery are characterized by fluctuations in hemodynamic and intracerebral pressures and present challenges for intrapartum anesthetic management. We report our experience with a patient with RCVS admitted for external cephalic version and subsequent vaginal delivery.
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Case Reports
Inappropriate Defibrillator Shocks During Cervical Medial Branch Radiofrequency Ablation: A Case Report.
A 52-year-old woman with a history of cervical spondylosis, nonischemic dilated cardiomyopathy, and complete heart block with implantation of a cardiac resynchronization therapy defibrillator (Inogen XR, Boston Scientific, Natick, MA) underwent bilateral fluoroscopy-guided radiofrequency ablation of the medial branch nerves at C4, C5, and C6 levels at an ambulatory surgery center. After completion of the seemingly routine procedure, several alerts, including 1 inappropriate shock, were received via Boston Scientific's remote monitoring system. Tracings also showed that pacing inhibition occurred. When performing radiofrequency ablation in patients with a cardiac implantable electronic device, it is imperative to follow published best practice recommendations to minimize the risk of adverse events.