Bilateral Femoral Neck Fractures in a 50-Year-Old Patient with Chronic Kidney Disease.

BACKGROUND Renal osteodystrophy is a serious complication of advanced chronic kidney disease (CKD). It predisposes the patient to fragility fracture and an increased risk of mortality. CASE REPORT We present the case of a 50-year-old male patient with stage 4 CKD and consequent renal osteodystrophy, who presented with a history of a recent provoked seizure, a severe electrolyte imbalance, and excruciating pain in the hip region. He had no history of a fall or trauma. A radiographic evaluation confirmed the rare finding of a bilateral femoral neck fracture. Upon stabilizing the patient, he was surgically managed with a bilateral hemiarthroplasty. A postoperative radiograph revealed a well-fixed prosthesis with no post-surgical complications. The patient had a full recovery. At the last follow-up visit, the patient was fully functional and had resumed normal activities. CONCLUSIONS This is a rare report with unusual mechanism of injury, involving a case of bilateral femoral neck fragility fractures, secondary to renal osteodystrophy in a stage 4 CKD patient. It draws the attention of medical care providers to the high risk of femoral fragility fractures that are secondary to renal osteodystrophy. Hemiarthroplasty is a safe and highly efficacious surgical option for managing such cases. This case also reiterates the dire need for greater public awareness and knowledge of CKD. Early diagnosis and treatment can substantially mitigate the associated morbidity and mortality.

Pressure-induced alopecia in pediatric patients following prolonged urological surgeries: The case reports and a review of literature.

Postoperative alopecia has been reported as a rare complication after prolonged immobilization during general anesthesia. The constant pressure on the scalp is causative and may be exacerbated by hypoxemia or hypotension. There is a correlation between the length surgery duration under anesthesia and the development of permanent alopecia. Regular head turning schedules and vigilance for the condition should be used as prophylaxis to prevent permanent alopecia.

Anesthetic management of patient with systemic lupus erythematosus and antiphospholipid antibodies syndrome for laparoscopic nephrectomy and cholecystectomy.

We report a case of a female having systemic lupus erythematosus and antiphospholipid antibodies syndrome, who was on immunosuppressant therapy. We discussed the preoperative evaluation and perioperative management who underwent nephrectomy and cholecystectomy.

Esmolol versus dexmedetomidine in scoliosis surgery: study on intraoperative blood loss and hemodynamic changes.

BACKGROUND: Surgical correction ofscoliosis carries significant blood loss and needs for blood transfusion with its inherent risks and cost. The aim of this double-blind, randomized, controlled study was to compare the effects of esmolol or dexmedetomidine on intraoperative blood loss, anesthetics consumption, intra operative hemodynamic and effects on spinal cord monitoring in patients undergoing scoliosis surgery. METHODS: After obtaining institute review board approval and written informed consent, 60 adolescents (ASA physical status I-II), 14-18-year of age scheduled for posterior spinal fusion scoliosis surgery were enrolled in the study. Using computer generator software patients were randomly allocated to receive either saline as a control (group C), esmolol (Group E) or dexmedetomidine (Group D). RESULTS: There was a significant reduction in blood loss in patients who received esmolol and dexmeditomidine compared to control it was as follow; in control group 782+/-86.4 ml (P < or = 0.001), esmolol group 667+/-145.2 ml (P < or = 0.001) and dexmeditomidine group 465 +/-115.3 ml (P < or = 0.001). Mean intraoperative total fentanyl and propofol consumption in the esmolol group was significantly higher than in the dexmedetomidine group, this was especially dramatic for the dexmedetomidine group where the propofol consumption was twice less P < or = 0.001. There was no significant effect seen in SSEPs (amplitude or latency) but there was isolated decrease in motor evoked potential (MEP) amplitude which was within acceptable range that was seen in 6 patients receiving dexmeditomidine at a dose of 0. 7 micro g/Kg/H. CONCLUSION: Both esmolol and dexmedetomidine, added to anesthetic regimen, provided an effective and well-tolerated method to reduce the amount of blood loss in patients undergoing scoliosis surgery. dexmedetomidine, was associated with plonoged extubation and recovery times.

Fatal air embolism during sigmoidoscopy performed under spinal anesthesia.

Air embolism is an uncommon but potentially catastrophic event that occurs when air enters the vasculature. Because of a scared and friable colorectal mucosa, patients with anastomotic stricture are at an increased risk of complications associated with sigmoidoscopy such as bowel perforation and bleeding. This is a report of fatal air embolism confirmed on an immediate postmortem chest radiograph in a patient with a high colorectal anastomotic stricture undergoing sigmoidoscopy under spinal anesthesia is reported. The literature on air embolism in patients undergoing sigmoidoscopy/colonoscopy is reviewed.

Efficacy of ultrasound-guided transversus abdominis plane (TAP) block for postcesarean section delivery analgesia--a double-blind, placebo-controlled, randomized study.

BACKGROUND: Ultrasound-guided transversus abdominis plane (TAP) block has been used for intra-operative and postoperative analgesia. Here we evaluate the efficacy of TAP block for postoperative cesarean delivery analgesia. METHOD: A randomized, double-blind, placebo-controlled trial was performed at King Khalid University Hospital on 40 patients undergoing cesarean delivery under spinal anesthesia with bupivacaine and fentanyl. At the end of surgery they received bilateral ultrasound-guided TAP block either with bupivacaine 0.25% (B group) 20 patients, or saline (S group, or placebo group) 20 patients, followed by patient controlled analgesia with i.v. morphine only. Each patient was assessed 24 hours after delivery for pain, morphine consumption, nausea, vomiting, sedation, patient's satisfaction, and also pain relief during mobilization (24 hours post-cesarean section). RESULTS: All 40 participants completed the study. Total morphine consumption was reduced more than 60% in the bupivacaine group; the bupivacaine group also reported improved satisfaction with their pain relief over 24 hours after surgery, reduced morphine consumption, less nausea, vomiting, and better patient's satisfaction. CONCLUSION: Ultrasound-guided TAP block improved postoperative analgesia, reduced morphine consumption and improved patient's satisfaction regarding analgesia after cesarean delivery.

Saudi patients' knowledge and attitude toward anesthesia and anesthesiologists--A prospective cross-sectional interview questionnaire.

BACKGROUND: Patients' awareness of the duties of anesthesiologists in the operating theatres may sometimes be limited. Many studies around the world proved lack of patient perception of the anesthesiologist's role in surgical practice. METHODS: One hundred and seventy operative patients were interviewed by anesthesiologists in the peri-operative period in King Khalid University Hospital at Riyadh KSA This paper reports the results of a prospective study on these patient's interviews by filling predetermined questionnaire by the interviewer. The survey was conducted on two sessions namely before anesthesia and surgery, and in the first post operative day. It included three sections exploring the demographical profile of the participant, knowledge about anesthesia procedure, assessment, anesthesiologists personnel, postoperative pain relief and the attitude toward the service given to him. RESULTS: Patients who recognized the anesthesiologists as specialized doctor consisted of 55.3%. But those who recognized anesthesia services during surgical intervention were only 16.5%. This result reflect ignorance of the public of the function of anesthesiologists, showed lack of perception regarding anesthesia procedures during surgery, and the role of the anesthesiologist in monitoring resuscitation and postoperative analgesia. Patients showed inclination to know more about the anesthesia services and choices and ranked the services from very good to excellent. The illiterate section of the studied population showed statistically significant correlation between their information on anesthesiologists and anesthesia, and their degree of education, level of income and habitat. CONCLUSIONS: Reasonable percentage of the patients knew that the anesthesiologist is a doctor who administers anesthesia. Services of anesthesiologists were highly appreciated, but their function during the operation and nature of anesthetics administered were poorly known. These results call for the necessity to educate the surgical patient by the anesthesiologists preoperative interview allow more time to establish rapport, by distributing educational material related to anesthesia and use of the media to educate illiterate section of the public on subjects pertaining to anesthesia.

Bilateral negative airway pressure pulmonary edema (NPPE)--a case report--.

A case of negative pressure bilateral pulmonary edema in a 28 years old healthy female patient, scheduled for diagnostic pelvic laparoscopy for infertility. Following extubation and apparent recovery from anesthesia, she had strong inspiratory efforts due to airway obstruction caused by coughing and laryngeal spasm, that lead to negative pressure bilateral pulmonary edema. The pulmonary edema disappeared within few hours. She was breathing spontaneously through CPAP system (mask-bag-expiratory valve). Diuretics and lungs physiotherapy helped in controlling patient's complication.