A&A practice
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The use of sodium-glucose cotransporter 2 (SGLT2) inhibitors is increasingly common in type 2 diabetes mellitus (DM) management. Patients taking an SGLT2 inhibitor are at risk for euglycemic diabetic ketoacidosis (EDKA). We report an intraoperative diagnosis of EDKA. ⋯ Acidosis resolved with insulin and glucose infusions. Perioperative specialists must recognize the potential for EDKA in patients taking SGLT2 inhibitors. Expert opinion suggests preoperative cessation for 2-3 days and intraoperative serum ketone concentration measurement for at-risk patients.
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Case Reports
Anesthetic Management of Robotic Thymectomy in a Patient With Morvan Syndrome: A Case Report.
Morvan syndrome (MvS) is a rare acquired paraneoplastic autoimmune neuromyotonia with central and autonomic nervous system involvement that has been incompletely described in the literature. We describe the successful administration of general anesthesia for robotic thymectomy to an MvS patient with severe encephalopathy, cardiac dysautonomia, and peripheral nerve hyperexcitation. Importantly, thymus removal provided effective source control with eventual resolution of MvS symptoms. MvS is briefly reviewed and novel observations are described of related interactions between nondepolarizing neuromuscular blockade (NDNMB) and bispectral index (BIS).
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The incidence of hip fractures in the United States is increasing as the population ages. Elderly patients are more likely to have extensive comorbidities, which contribute to long-term consequences after a hip fracture. These patients often experience permanent disability, restrictions in activities of daily life, higher rates of depression, cardiovascular disease, and mortality rate. The authors describe a combination of peripheral nerve blocks to provide surgical anesthesia for corrective hip surgery in 5 high-risk patients.
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Review Case Reports
Case Report of Remifentanil Labor Analgesia for a Pregnant Patient With Congenital Methemoglobinemia Type 1.
Congenital methemoglobinemia is a rare disease characterized by cyanosis and a left shifting of the oxyhemoglobin dissociation curve. The disease necessitates avoidance of certain medications commonly used in obstetrics, making labor analgesia and anesthesia challenging. ⋯ Continuous real-time monitoring of methemoglobin concentrations may prove to be a useful monitor in future care settings. A review of literature encompassing various perioperative and obstetric anesthesia and analgesia management considerations is presented.
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Case Reports
Utilization of Magnesium in Opioid-Free Anesthesia for Peroral Endoscopic Myotomy: A Case Report.
Optimal anesthetic management has not been studied for peroral endoscopic myotomy (POEM). This case report documents 2 patients with esophageal motility disorders who underwent POEM with opioid-free, magnesium-based anesthesia. Both patients had no postoperative esophageal complications nor need for opioid therapy. We further describe the therapeutic potential of magnesium for management of esophageal pain.