A&A practice
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Case Reports
Electroencephalogram-Guided General Anesthesia in a Pediatric Patient With Alexander's Disease: A Case Report.
In this case, the electroencephalogram (EEG) was used to guide anesthesia care for a pediatric patient with Alexander's Disease undergoing serial intrathecal injections. Previous procedures using a standard maintenance propofol dose of up to 225 µg/kg/min led to postanesthetic recovery times of over 6 hours, requiring a neurology consult for noncoherence. The EEG assisted in guiding maintenance propofol dosing to 75 µg/kg/min, decreasing postanesthetic wash-off and postanesthesia care unit (PACU) recovery time by 50%. This highlights the potential impact of astrocyte dysfunction on anesthetic sensitivity and robustness of EEG as a biomarker of anesthetic effect, including for pediatric patients with rare neurodevelopmental diseases.
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Transcatheter aortic valve replacement (TAVR) is a common treatment for severe aortic stenosis (AS), but it carries the risk of severe complications, including device embolization. We present a case of a TAVR valve embolization into the left ventricular outflow tract (LVOT), diagnosed with transesophageal echocardiography (TEE) shortly after device deployment. The dislodged valve was successfully retrieved from the LVOT into the aorta, flattened, and stabilized with a thoracic endovascular aneurysm repair (TEVAR) stent, enabling the successful implantation of a new TAVR valve.
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Numerous barriers hinder the effective delivery of neurologic care as well as the education of health care professionals in the low-income and middle-income countries (LMICs). This study assessed the knowledge of the participants after Comprehensive Neurocritical Care Course (CN3C) in the LMICs. ⋯ There was improvement in their posttest scores (pretest score: 16.45 ± 5.35 vs posttest score: 24.96 ± 6.74; P < .01). The CN3C course improves the overall knowledge of neurocritical care in the participants, as evident by the posttest scores.
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Intercostal neuralgia can be debilitating and extremely difficult to treat despite multi-modal therapies. The literature describing the role of neuromodulation in patients with intercostal neuralgia is scarce. In this medically challenging case report, we describe a 56-year-old male with a near complete resolution of intractable chronic intercostal neuralgia, secondary to traumatic rib fractures and multiple surgical interventions, with a single lead thoracic spinal cord stimulator (SCS) implant. Neuromodulation therapies should be considered as a viable option for this patient population.