A&A practice
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Spontaneous intracranial hypotension (SIH) has been increasingly characterized in recent years. A definitive diagnostic algorithm remains controversial because several symptoms are often found to be nonspecific. ⋯ Our case shows how greater occipital nerve block (GONB) can expedite SIH diagnosis in a man with atypical presentation by reducing the sensory input from the posterior cranial fossa. The relief provided by GONB allowed to diagnose SIH promptly and the patient underwent a curative EBP.
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Case Reports
A Novel Approach to Postoperative Ear Pain-Greater Auricular Nerve Block Catheter: A Case Report.
A 70-year-old man presented for repair of an ear avulsion injury sustained from an all-terrain vehicle accident. A continuous technique using a catheter for a greater auricular nerve (GAN) block was performed in the preoperative area followed by general anesthesia in the operating room. ⋯ The GAN catheter was kept in place for 3 days with near-complete pain relief per the patient. To our knowledge, there are no case reports that describe a continuous GAN technique for surgery and postoperative pain.
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Case Reports
Eighteenth Century Complications With 21st Century General Anesthesia: A Case Report of Scurvy.
Autism spectrum disorder (ASD) may be associated with self-imposed dietary restrictions causing nutritional deficiencies, and the anesthesiologist must be aware of their potential clinical implications. Because humans are unable to produce ascorbic acid through endogenous metabolic pathways and children with ASD may avoid vitamin C-containing foods, vitamin C deficiency, or scurvy, may develop in patients scheduled for general anesthesia. Vitamin C deficiency may cause dysfunction in autonomic nervous system processes or pulmonary hypertension resulting in unexpected hemodynamic lability. We describe a child with ASD and limited dietary options leading to undiagnosed scurvy and intraoperative hypotension.
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Spinal anesthesia is administered for select procedures in the pediatric population and offers a safe alternative to general anesthesia. In this case series, we report loss of corneal and eyelash reflexes in 4 children who underwent spinal anesthesia for lower abdominal procedures. While initially thought to be the result of higher-than-intended spinal anesthesia, the observation that gentle stimulation produced vigorous phonation, orbicularis oculi constriction, and upper extremity movement suggests an alternative mechanism. This finding highlights a potential gap in knowledge related to the effect spinal anesthesia has on brain dynamics in children.
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Patients with anterior mediastinal masses pose a significant challenge to anesthesiologists. Catastrophic outcomes have been described in patients with mediastinal masses undergoing anesthesia. However, despite an abundance of literature discussing anesthetic management of these patients, there is a lack of reports detailing the management of this population undergoing advanced endoscopic procedures under sedation. We report on a 28-year-old man with a large anterior mediastinal mass who underwent endoscopic retrograde cholangiopancreatography in the prone position under moderate to deep sedation without complication.