A&A practice
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A 65-year-old man undergoing posterior cervical decompression and fusion demonstrated absent lower extremity evoked potential (EP) after prone positioning and before incision. Localized EP change pointed to either a technical or positional culprit. ⋯ During the test, we observed both symmetrical and asymmetrical hemispheric changes in density spectral array β and γ bands that correlated with awakening, eye-opening, and extremity movements. By providing real-time information on brain state, processed electroencephalogram (EEG) can facilitate a safe wake-up test by showing high-power β and γ activities that precede awakening.
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Case Reports
Iatrogenic Aortic Intramural Hematoma: Guidance to Intraoperative Decision Making: A Case Report.
Aortic intramural hematoma (IMH) is a collection of blood within the aortic wall without an identifiable intimal tear. It belongs to the spectrum of acute aortic syndrome (AAS) which also includes aortic dissection (AD), a well-defined entity. ⋯ But with recent advances in imaging, certain features of IMH have been identified that affect the natural course of IMH. We report a unique case of iatrogenic IMH complicating a routine coronary artery bypass graft surgery (CABG) and how imaging guided intraoperative decision making toward conservative management.
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Venoarterial extracorporeal membrane oxygenation (vaECMO) is a well-established treatment option for severe cardiogenic shock of various etiologies. Although trials have explored weaning strategies, a brief and conclusive overview is lacking. We present the different aspects of weaning and provide an evidence- and experienced-based guide for clinicians managing patients under vaECMO in the preweaning, weaning, and postweaning phases.
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Case Reports
Unanticipated Myocarditis in a Surgical Patient Treated With Pembrolizumab: A Case Report.
We report a case of fatal immune checkpoint inhibitor (ICI)-associated myocarditis in a 77-year-old man with metastatic non-small cell lung cancer (NSCLC) who presented for mediport placement at our outpatient surgical center. He denied any cardiac complaints and had a previously normal electrocardiogram (EKG) off treatment. ⋯ The patient was then transferred to a tertiary facility, where he expired within 48 hours. As cancer immunotherapy becomes increasingly prominent, ICI-associated myocarditis should be considered a potentially critical contributor to perioperative cardiac morbidity and mortality.
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Despite conservative and surgical treatments, patients with neurogenic thoracic outlet syndrome can develop debilitating chronic pain of the shoulder and arm. Here we report a case of a patient who failed medical treatment, surgical resection of the first rib, and subsequent resection of rib regrowth with partial excision of a hypertrophied middle scalene muscle. Ultimately, this patient was successfully treated with spinal cord stimulation with dramatic pain relief and remarkable functional improvement for more than 3 years. This first report provides hope for those who suffer from this debilitating syndrome.