ABSTRACT
Epidural anesthesia (EA) involves reaching the spinal epidural space with an anesthetic drug injection. This procedure provides pain relief during labor. Although EA can lead to some complications, subdural hemorrhage (SDH) is a rare adverse event associated with it. We report the case of a 25-year-old female patient who presented to our emergency department with a one-month history of headaches and associated blurred vision following a normal vaginal delivery with EA. She was initially treated as a case of post-dural puncture headache (PDPH), with no improvement. Finally, the diagnosis of bilateral SDH was made based on a brain MRI. She required surgical intervention, which led to a positive prognosis and a full return of normal baseline neurological functions. Only a few reports in the literature have indicated the possibility of cranial subdural hematoma formation associated with spinal or epidural analgesia. Our patient experienced a delay in her diagnosis and treatment, as SDH following EA is a rare entity. It is important to follow up with such patients and consider other possibilities when symptoms fail to resolve. Also, reporting these cases is crucial to assist clinicians in early diagnosis and treatment, and to avoid disastrous outcomes.
ABSTRACT
Tranexamic acid has been increasingly used due to its safety and effectiveness. It has been associated with multiple reported cases of errors due to lack of attention, incorrect labeling of the syringes, or look-alike with other medications leading to the incorrect route of injection and the associated catastrophic sequela. Here we report a case of wrong route injection of tranexamic acid during spinal anesthesia, leading to myoclonic seizures and eventually intensive care unit admission of a patient undergoing orthopedic surgery. It is reported that higher doses of tranexamic acid would cause massive sympathetic discharge as evidenced by the initial hypertensive response reported in our case report and also in some repeated patient. Tranexamic acid induced seizures either from direct cerebral ischemia secondary to decreases in regional or global or from neuronal hyperexcitability by blockage of inhibitory cortical-gamma aminobutyric acid (GABA)-A receptors. Some evidence has been shown for dose-related neurotoxicity in the animal model, with greater severity and duration of seizure with increasing doses.
ABSTRACT
BACKGROUND: Traditionally, intubation of pregnant women has been performed using a rapid sequence induction. This is due to the classical concept that women with more than 18 weeks of pregnancy (mid-second trimester) are always considered to have an increased risk of aspiration due to a number of factors, regardless of the fasting duration. Rapid sequence induction is associated with a higher rate of adverse events. AIMS: Our study aimed to illuminate the hypothesis that there is no difference in gastric volume between term-pregnant women and non-pregnant or first-trimester pregnant women who were undergoing minor gynecological surgical procedures. Accordingly, we measured gastric volume and content before anesthesia in term-pregnant women undergoing elective cesarean section, and to compare it with non-pregnant or first-trimester pregnant women who were undergoing minor gynecological surgical procedures. METHODS: In this single-center prospective study, the gastric volume and content were assessed by abdominal ultrasound (AUS) just prior to the scheduled procedure. AUS was performed in the sagittal or para-sagittal plain in the upright position and the stomach content was estimated according to the antral circumferential area. Group 1 consisted of 50 term-pregnant women scheduled for cesarean section. Group 2 consisted of 45 non-pregnant or first-trimester pregnant women who were scheduled for minor gynecologic procedure. RESULTS: Despite significant longer fasting time prior to the interventional procedure in the non-pregnant or first-trimester women group, there was no significant difference in gastric volume between term-pregnant and first-trimester pregnant women (3.2 ± 0.97 cm2 vs 3.2 ± 0.79 cm2; P = .97). Gastric volume was small in the two groups. CONCLUSION: Fasting gastric volume before cesarean section in term-pregnant women is small and is not different than in non-pregnant or first-trimester women undergoing minor gynecologic procedures. Ultrasound estimation of gastric volume is a reliable and easy-to-perform technique which might help in decision-making regarding the airway management prior to induction of anesthesia in pregnant women.
ABSTRACT
PURPOSE: Although previously frozen shoulder was thought to resolve by two to three years, recent studies demonstrated the symptoms can remain for much longer. Manipulation under anaesthetic (MUA) has been shown to be successful in relieving pain and restoring function. Yet, concerns have been raised regarding its safety and the risks of complications. We utilise Codman's paradox to manipulate the shoulder, avoiding rotational torque on the humerus. The aim of our study was to asses shoulder function in the early post MUA period. METHODS: Two hundred twelve consecutive patients (224 shoulders) (mean age 52.4 years) underwent MUA using Codman's paradox for frozen shoulder as sole procedure between 2005 and 2013. All were evaluated clinically, preoperatively and postoperatively, at three weeks and three months, for Constant score (CS), pain, range of motion (ROM), patient satisfaction and subjective shoulder value (SSV). RESULTS: At three weeks and three months, a significant improvement was found in CS from 30.7 to 66 and 70 respectively. Forward elevation improved from 91° to 154° and 160 °, abduction from 69° to 150° and 156 °, internal rotation from 12° to 62° and 66 °, and external rotation from 10° to 46° and 50 °. Pain score improved from 4.4/15 to 9.6/15 and 10.4/15, SSV improved from 1.5/10 to 6.5/10 and 6.7/10. (p<0.001). CONCLUSION: Use of Codman's paradox provides a safe and efficient way to perform MUA for frozen shoulder. It results in dramatic early improvement in ROM, functional outcomes and high satisfaction, as early as three weeks post-operatively.
Subject(s)
Bursitis/therapy , Manipulation, Orthopedic/methods , Shoulder Joint/physiopathology , Adult , Aged , Anesthetics/administration & dosage , Female , Humans , Male , Manipulation, Orthopedic/adverse effects , Middle Aged , Pain Measurement/methods , Range of Motion, Articular/physiology , Recovery of Function , Retrospective Studies , Shoulder Pain/etiology , Shoulder Pain/therapy , Treatment OutcomeABSTRACT
Objective To study the best multiple concentration of target controlled infusion of propofol and remifentanil in elderly patients during the induction of general anesthesia. Methods Fifty elderly patients were randomized into five groups, according to the effect site concentration of remifentanil (0, 2, 4, 6, 8 ng/mL). We started the effect site concentration of propofol (PEC) at 2 μg/mL, and added 1 μg/mL every 2 min until bispectral index (BIS) was stable at 40±5. During the induction,we recorded the effect site concentration of remifentanil (REC) and propofol (PEC), heart rate (HR), arterial blood pressure (ABP), BIS, AAI, and isolated forearm technique (IFT). After statistic analysis, the best multiple concentration was judged. Results There was no significant difference (P<0.05) in the changes of hypertension and hypotension among these five groups during intubation. The most smooth hemodynamic conditions were found in group B, i.e. 20% and 10%, respectively. When consciousness was lost, there was a negative correlation between PEC and REC. Group B was the minimum on the change of IFT and the cardiovascular system among these five groups at tracheal intubation. Conclusions It is safe and stable to use REC 2 μg/mL for TCI, combined with propofol in elderly patients under general anesthesia. PEC is (3.5±0.8)μg/mL when the patients' consciousness is lost. And PEC is 5.3 μg/mL at tracheal intubation.