A&A practice
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This case report describes a 29-year-old patient with cerebral palsy whose mother, for safety reasons, requested that before extubation in the postanesthesia care unit, her son be transferred from the padded stretcher to his personal motorized wheelchair. Using a sling lift, we safely transferred the anesthetized, intubated patient from a supine position to an upright sitting position. Although sling lifts are often used in critical care and rehabilitation environments, use in the perioperative space is rare. In this case report, we demonstrate how a sling lift can enhance safety for patients and perioperative staff.
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We describe a patient with severe Arnold Chiari Malformation and syringomyelia who underwent gynecological laparoscopy in an emergency context; no brain imaging was available. We here report the successful use of optic nerve sheath diameter (ONSD) and middle cerebral artery (MCA) velocity measurements as surrogate monitoring for cerebral blood flow and intracranial pressure, respectively. MCA velocity was low when assessed after peritoneal insufflation and ONSD increased to 6.3 mm after Trendelenburg positioning. This noninvasive Ultrasound and Doppler neurological monitoring helped adapt the anesthetic management and the patient recovered both normal ONSD and MCA velocity values.
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Review Case Reports
Pain Management in Brugada Syndrome: A Case Report and Review.
Brugada syndrome is a rare condition that increases the risk of life-threatening arrhythmias. Although there are existing anesthesia recommendations for patients with Brugada syndrome, guidance on pain management is limited. ⋯ She received perioperative multimodal analgesia, which included neuropathic agents (pregabalin, duloxetine), and opioids (morphine, codeine). Our findings contribute to a greater understanding of safe analgesic practices for patients with Brugada syndrome.
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Carbon dioxide gas emboli is a potentially fatal complication that occurs more frequently during laparoscopic hepatectomy compared to other laparoscopic surgeries. The patient featured in this report had massive gas embolism confirmed by intraoperative transesophageal echocardiography (TEE) that were associated with episodes of severe hypoxemia, hemodynamic instability, and right ventricular failure requiring conversion to open hepatectomy. Abrupt abdominal decompression resulted in massive hemorrhage from a previously undetected defect in the middle hepatic vein. The report demonstrates the successful management of gas embolism during laparoscopic hepatectomy even with a significant delay in vascular repair and highlights the critical role of TEE.
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Case Reports
Does the Diagnosis of Intraoperative Malignant Hyperthermia Require Case Termination? A Case Report.
Malignant hyperthermia (MH) is a rare genetic disorder triggered by inhalational anesthetics or depolarizing neuromuscular blocking agents that carries significant mortality if not promptly treated. The following case presents a healthy 39-year-old man who developed MH several hours into an anesthetic exposure. Rapid intraoperative stabilization tactics that paralleled intensive care unit (ICU) level care allowed for continuation of operative management as opposed to case termination given the patient was at high risk for permanent nerve palsy if the case were to be aborted during dissection.