Epidural Anesthesia for Neuromyelitis Optica in Obstetrics: A Case Report and Literature Review.

Neuromyelitis optica (NMO), also known as Devic disease, poses unique challenges in obstetrical anesthesia, with limited research available. This case report presents the anesthetic management of a 43-year-old gravida 2 para 1 (G2P1) woman with NMO undergoing labor induction at 39 weeks of gestation. Having received uneventful epidural labor analgesia in her first pregnancy, she faced the delicate decision of neuraxial anesthesia in light of her NMO diagnosis, which was made following her initial pregnancy. Collaborative discussions resulted in the choice of labor epidural analgesia, and an indwelling epidural catheter was placed successfully. An unplanned cesarean section with effective epidural supplementation followed. The case highlights the intricacies of balancing pain relief and neurological risks in NMO patients. Existing literature reflects varying perspectives on neuraxial anesthesia in NMO, with reports both supporting and cautioning against its use. The case aligns with the current view that epidural labor analgesia appears safe in NMO, but conclusive recommendations await larger studies. The decision for neuraxial anesthesia in NMO should be individualized, guided by comprehensive pre-anesthetic counseling and ongoing research developments.

Postoperative abdominal free air: How much and when is enough? Report of two cases.

Postoperative intraperitoneal or ectopic free air may occur after abdominal surgery, gynecologic surgery, laparoscopic surgery, or endoscopic procedures and, in rare cases, represent gastrointestinal perforation, requiring emergency laparotomy. Evaluating patients with postoperative signs of bowel perforation may be difficult, especially when day-case laparoscopic or endoscopic surgery is performed, with the patient readily discharged from hospital. Delayed diagnosis of gastrointestinal perforation due to underestimation of postoperative free air is associated with a high morbidity and mortality rate. We report two cases of patients presenting with postoperative free air along with the clinical presentation and management.

Free air after laparoscopic hysterectomy; from sigmoid perforation to upper airway compromise: a case report.

BACKGROUND: Free air after laparoscopic hysterectomy is a common finding; in rare cases, free air represents gastrointestinal perforation, requiring emergency laparotomy. Ectopic air localizations after pneumoperitoneum have been reported in various laparoscopic surgical techniques. Delayed diagnosis of visceral perforation is associated with high mortality rates. CASE PRESENTATION: We present a white Caucasian female in which dysphonia due to air entrapment in the cervical area, pneumomediastinum and pneumothorax, occured afterlaparoscopic hysterectomy. CONCLUSIONS: Upon mobilization of the patient, air from sigmoid perforation moved cephalad. Through the same path, pneumoperitoneum, causes subcutaneous emphysema in the neck and face, pneumomediastinum and pneumothorax.

Severe anaphylactic shock after anesthesia induction: An unusual initial manifestation of Churg-Strauss syndrome.

Churg-Strauss syndrome or eosinophilic granulomatosis with polyangiitits (EGPA) is a rare multisystem disorder. A case of anaphylactic shock after induction of anesthesia, as the initial clinical presentation of Churg-Strauss syndrome in a 15-year-old girl is reported. It is extremely rare to see pediatric patients with previous perioperative anaphylaxis receiving future anesthesia; a multidisciplinary approach including allergist, rheumatologist, anesthesiologist, and surgeon is necessary in order to provide a better future anesthetic plan.