Neuraxial Anesthesia and Lower Extremity Peripheral Nerve Blocks for Ankle Surgery in a Patient With Chronic Inflammatory Demyelinating Polyneuropathy: A Case Report.

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rare autoimmune disease that targets the peripheral nervous system. The literature on the use of regional anesthesia in CIDP is limited. We report a patient with CIDP who received a combined spinal-epidural (CSE) and saphenous and popliteal peripheral nerve blocks (PNBs) for ankle surgery. The CSE and PNBs resolved without incident. On approximately the fourth postoperative day, the patient reported a worsening of baseline CIDP symptoms in all extremities. Given the diffuse presentation, the CIDP exacerbation was attributed to the perioperative stress response. The exacerbation improved by 4 months postoperatively.

Heparin Resistance due to an Acquired Antithrombin Deficiency in a Patient With Sickle Cell Disease During a Pregnancy Complicated by Bilateral Pulmonary Emboli: A Case Report.

We report a 31-year-old woman with sickle beta thalassemia zero who presented at 21 weeks gestational age with multiple bilateral pulmonary emboli and no hemodynamic instability. Acquired antithrombin deficiency was suspected due to a refractory response to therapeutic anticoagulation with enoxaparin, unfractionated heparin, and fondaparinux, and a reduced antithrombin antigen level. At 26 4/7 weeks, she developed signs concerning for increased pulmonary clot burden. To avoid the use of alternative anticoagulants that may cross the placenta and impact the fetus, a planned cesarean delivery was performed without complication at 27 weeks gestation. Both mother and child experienced successful long-term outcomes.