Unreported Source of Interference with the Bispectral Index During Liposuction: A Case Report.

Incorrect bispectral index (BIS) values have been reported due to interference with this monitoring system. We report a case of a 46-year-old woman who underwent liposuction and breast lipofilling, where we observed a misinterpretation by the BIS algorithm that has not yet been reported. Concurrently with abdominal and thigh liposuction, an increase in the BIS value was observed. The importance of examining electroencephalogram (EEG) and density spectral array (DSA) readings during liposuction procedures is highlighted in this case report, extending our observations beyond just the numerical BIS value, which is not always reliable.

Cardiac Arrest in the Post-anesthesia Care Unit (PACU): Postoperative Recurrence of Neuromuscular Block After Sugammadex Reversal.

Sugammadex has transformed clinical practice by enabling the rapid reversal of rocuronium-induced neuromuscular block (NMB) at any depth. We present a case of cardiac arrest following postoperative recurarization despite the sugammadex-induced transient reversal of NMB. Despite its proven clinical reliability, this case highlights the often overlooked aspects that must be considered when using this drug. An 84-year-old male patient was scheduled for a laparoscopic partial gastrectomy for gastric cancer. At the end of the procedure, reversal of NMB was evidenced by an acceleromyographic train-of-four (TOF) ratio of ≥0.9 following sugammadex administration. In the post-anesthesia care unit (PACU), pulseless electrical activity was perceived, with a regression of TOF count to 1. After providing successful advanced cardiac life support, additional sugammadex administration led to uneventful extubation. When the concentration of free rocuronium decreases in the central compartment following sugammadex administration, redistribution of rocuronium from the peripheral to the central and effect-site compartments may cause recurarization. Special care is required in cases involving obese and elderly patients as well as those with renal impairment or hypothermia. To provide effective and predictable reversal of NMB, proper use of sugammadex should be pursued, including adequate dosing and monitoring.

Epidural Catheter Migration: A Case Report of a CT Scan Examination.

Epidural catheter placement is one of the most effective, secure, and worldwide used pain control modalities. Epidural catheter dislodgment is a common cause of epidural block failure. The diagnosis of this situation is usually presumptive, and cases in which the actual trajectory and final location of the catheter are witnessed by imaging are rare. We present two cases of the insufficient epidural block due to catheter migration, confirmed by a CT scan with radiopaque contrast injection through the catheter. In the first case, the catheter tip was identified in the left major psoas muscle. Some catheter holes were probably located in a border zone between two compartments, which made the analgesic efficacy dependent on the infusion rate. In the second case, the catheter tip was identified as lodged in the left paravertebral space, which explains only unilateral left pain relief. In selected situations, like repeated ineffectiveness and in pretended long-duration catheters, imaging tests may be useful to determine the actual position of the catheter and identify anatomical variations that may lead to an incorrect replacement.