Acta anaesthesiologica Belgica
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Acta Anaesthesiol Belg · Jan 2012
Case ReportsCervical epidural anesthesia in post stroke patients: are we safe?
The role of regional anesthetic techniques such as cervical epidural and inter-scalene brachial plexus blockade (ISB) in rehabilitated stroke patients remains uncertain. We present a case of rehabilitated stroke patient with reactive airway disease, which was managed using cervical epidural anesthesia for an above the elbow amputation. We further discuss the implications of the performance of cervical epidural anesthesia in post stroke patients.
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Methemoglobinemia is a rare pathology that results from the oxidation of iron in the hemoglobin molecule. Oxidation of iron switches it from the ferrous to the ferric state, and impedes the ability of hemoglobin to carry oxygen. Hence, methemoglobinemia often results in hypoxemia. ⋯ The first one is a 24-year old woman, who received dapsone as an alternative antibiotic therapy because of known allergies to a series of other antibiotics and who could not get weaned from mechanical ventilation despite minimal ventilator support. The second case describes a 49-year old man who developed respiratory insufficiency following the use of 'poppers' containing alkyl nitrites. Following treatment of both patients using the antidote methylene blue, they could be successfully weaned from mechanical ventilation.