A&A practice
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Case Reports
Lidocaine Infusion for the Treatment of Headache Associated With Subarachnoid Hemorrhage: A Case Report.
Headache after subarachnoid hemorrhage and corresponding craniotomy with aneurysm clipping can be severe and difficult to treat. Currently accepted analgesic therapies are often ineffective at treating the pain without incurring unacceptable side effects. ⋯ Opioid consumption fell to zero for both patients during lidocaine infusions without lidocaine toxicity. Moreover, after discontinuation of lidocaine infusions, both patients reported good pain control using only standard oral medications.
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Case Reports
Bilateral Sphenopalatine Ganglion Block With Liposomal Bupivacaine Followed by Severe Hypertension: A Case Report.
We reviewed a case of bilateral sphenopalatine ganglion (SPG) blockade with liposomal bupivacaine for sinus surgery. The case was complicated by severe postoperative hypertension refractory to antihypertensives and needing intensive care unit (ICU) admission. ⋯ We discuss how local anesthetic spread beyond the SPG may have caused prolonged parasympathetic blockade and hypertension. Before approved indications are established, we recommend avoiding the use of liposomal bupivacaine in off-label settings when the function of bilateral autonomic structures could be affected.
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Case Reports
Asymptomatic Penetration of the Median Nerve by a Peripherally Inserted Central Catheter: A Case Report.
We report a rare case in which a peripherally inserted central catheter (PICC) asymptomatically penetrated the median nerve. The patient was a 71-year-old man who displayed no neurological symptoms until 4 days after PICC placement. ⋯ When placing a PICC, selecting the brachial vein as a puncture site is associated with a high risk of nerve injury. Furthermore, circumspect observation is needed until withdrawal as neurological symptoms may be absent even when the catheter has punctured a nerve.
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We report a case of a 72-year-old woman who experienced postictal episodes of trismus lasting several minutes on 6 occasions during a series of 18 episodes of electroconvulsive therapy (ECT). There was no clear relationship between the development of trismus and any medications used during the treatments. The patient had no adverse outcomes or discomfort, but the development of trismus can put patients at significant risk.
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Case Reports
A Case Report of "Propofol Frenzy": Anesthetic Considerations for a Severe Propofol-Induced Neuroexcitation Reaction.
Propofol "frenzy" is considered a severe propofol-induced neuroexcitatory reaction involving nonepileptic spells of extremity thrashing, marked agitation, irregular eye movements, and impaired consciousness. Patients with propofol neuroexcitation present unique challenges for anesthesia providers due to underrecognition, lack of diagnostic tests, and differentiating from other comparable disorders that require medications that can exacerbate symptoms. We present a case of a healthy young patient whose postoperative course was complicated by propofol frenzy and functional limb paralysis following hip surgery with a spinal anesthetic and propofol sedation. This case highlights anesthesia considerations for propofol frenzy and discusses dexmedetomidine as a promising modality for prompt management.