A & A case reports
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We report a previously undescribed complication associated with percutaneous maxillary nerve blockade. After the procedure, the patient reported an inability to close her ipsilateral eye (lagophthalmos). The patient had received 5 mL of 0.5% lidocaine for skin anesthesia. ⋯ The likely cause was local anesthetic effect on the zygomatic branches of the facial nerve. When subcutaneous local anesthetic is given for maxillary block, smaller volumes should be considered. Doctors and patients should be aware of this complication, which may require treatment with artificial tears or patching of the eye to prevent corneal injury.
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Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a recently identified syndrome characterized by psychosis and dysautonomia. Treatment includes resection of the underlying tumor. ⋯ We report a classic presentation of anti-NMDA receptor encephalitis and describe the use of total IV anesthesia with NMDA receptor-sparing drugs. Modest postoperative analgesic requirements, not reported in prior cases, are also described in our report.
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Progressive encephalomyelitis with rigidity and myoclonus (PERM) is a rare autoimmune neurological condition. Antibodies targeting glycine receptors (GlyR) have been implicated in PERM. ⋯ We describe a case of general anesthesia in a patient with PERM and GlyR antibodies. This patient did not demonstrate a clinically significant alteration in the behavioral effects of anesthesia using induction of anesthesia with sevoflurane and maintenance of anesthesia using sevoflurane and nitrous oxide.
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We present a case of massive spinal epidural hematoma with an atypical presentation characterized by unilateral, isolated motor deficit in the right lower extremity on postoperative day 2 after Collis-Nissen fundoplication and a T7-8 epidural for postoperative pain. The epidural had been placed in the preoperative theater before surgery. Subcutaneous unfractionated heparin was initiated 18 hours later on postoperative day 1 with 3 times daily dosing. ⋯ Symptoms were first reported on postoperative day 2, 37 hours after epidural placement. Thoracic magnetic resonance imaging showed an epidural hematoma extending from T2 through T12, requiring emergent decompression and evacuation. The patient made a complete recovery without any resultant neurologic deficit.