Spontaneous Cecal Perforation During Pregnancy.

Spontaneous perforation of the colon is a rare disease defined as sudden perforation of a healthy colon without evidence of trauma or disease. These perforations are typically classified as either stercoral or idiopathic. Cecal perforation during pregnancy is an uncommon and potentially life-threatening condition requiring prompt recognition and surgical intervention. We present a case of a 33-year-old woman at 29 weeks and three days gestation presenting with spontaneous cecal perforation. She presented to the emergency department with diffuse abdominal pain and distention lasting for three days, associated with nausea and vomiting. Following evaluation, she was diagnosed with diffuse peritonitis. The diagnosis of this condition relies on both the clinical presentation and the utilization of radiographic imaging. The patient underwent an emergent explorative laparotomy with prompt surgical intervention to repair the 1.2 x 0.8 cm perforation found on her distended cecum. The surgical repair consisted of the excision of the edges and the primary suture of the perforation with an omental patch. Her post-procedure course was uneventful, and she later delivered a healthy baby at full term. This case highlights the importance of considering uncommon causes of acute abdominal pain in pregnant women to ensure timely diagnosis and management.

Emergency department procedural sedation with propofol: is it safe?

Propofol is a sedative agent gaining popularity for Emergency Department Procedural Sedation (EDPS). However, some institutions across the country continue to restrict the use of propofol secondary to safety concerns. The purpose of our study was to evaluate the complication rate of EDPS with propofol. We conducted a prospective, observational, multi-center study of EDPS patients aged > or = 18 years, consenting to procedural sedation with propofol. Eighty-two patients from two Level I trauma centers were enrolled between August 1, 2002 and January 31, 2003. Transient hypoxemia was the only noted sedation complication. Nine patients (11%) had brief hypoxemia. The combined average hypoxemia time was 1.2 min (SD 0.4), and in all instances responded to simple airway maneuvers or increased oxygen concentration. No patient required advanced airway maneuvers such as intubation or even positive pressure ventilation. EDPS with propofol seems to be safe in our population.

An assessment of the association of bispectral index with 2 clinical sedation scales for monitoring depth of procedural sedation.

OBJECTIVE: We conducted a study to assess the correlation of bispectral index (BIS) to 2 clinical sedation scales. METHODS: This was a prospective, observational study. The BIS number was recorded at baseline and every 30 seconds. One investigator separately monitored the patients for depth of sedation using the Observer's Assessment of Alertness/Sedation and the Continuum of Depth of Sedation scales. RESULTS: During the 6-month period, 75 patients were enrolled. The Spearman correlation between the BIS and the Observer's Assessment of Alertness/Sedation was 0.59 (95% confidence interval [CI], 0.44-0.74). The Spearman correlation between the BIS and the Continuum of Depth of Sedation was 0.53 (95% CI, 0.36-0.70). The mean minimum BIS for patients without a complication was 70 (SD, 15.9) compared with 68 (SD, 12.9) for patients with a complication (difference = 2; 95% CI, -7-11). CONCLUSIONS: Our study demonstrated moderate correlation between BIS and the 2 clinical sedation scales. The correlation is not strong enough to be used reliably in a clinical setting. The mean minimum BIS scores were not significantly different for those with sedation complications vs those without complications.