A&A practice
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Case Reports
Decreased Cerebral Perfusion Under Anesthesia During Radiation Treatment: A Case Report.
Radiation therapy allows patients to receive focused radiation to a tumor. Some patients require anesthesia for their daily treatments. For head and neck tumors, a thermoplastic mask is created to minimize movement. ⋯ This led to cerebral hypoxia. Cerebral oximetry confirmed this diagnosis, and the patient's mask was refitted-remaining anesthetics were uneventful. Mask fitness should be reassessed during the treatment series.
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Arthroscopic knee surgery is a common trigger for lower extremity complex regional pain syndrome (CRPS). Few studies assess nerve block catheters for CRPS treatment; they do not appear to be studies of regional anesthesia to treat CRPS that occurs after knee surgery. We present a case of CRPS-I triggered by knee surgery on multiple prior occasions but finally prevented by perineural adductor canal catheter placement. The literature presents only moderate evidence supporting interventions such as intravenous regional anesthesia and sympathetic blockade; continuous nerve blockade may be an effective treatment of CRPS-I and in particular postoperative CRPS-I.
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Case Reports
Anesthetic Management of a Patient With S-Adenosylhomocysteine Hydrolase Deficiency: A Case Report.
S-adenosylhomocysteine hydrolase (AHCY) deficiency is a rare congenital disorder in methionine metabolism with minimal guidelines regarding anesthetic management. This case report describes a 19-year-old man presenting for a liver biopsy in interventional radiology due to a history of elevated aminotransferases and creatine kinase. He received dextrose-containing fluids and a total intravenous anesthetic to avoid rhabdomyolysis and hyperkalemia. Anesthetic goals for patients with AHCY deficiency should focus on avoiding rhabdomyolysis, minimizing postoperative ventilatory compromise, monitoring for potential coagulopathy, and providing anxiolysis.