A & A Case Reports

Panchamia, Jason K.; Amundson, Adam W.; Demirci, Onur; Braksick, Sherri A.; Wijdicks, Eelco F.

doi: 10.1213/xaa.0000000000001569pmid: 35299226

Propofol “frenzy” is considered a severe propofol-induced neuroexcitatory reaction involving nonepileptic spells of extremity thrashing, marked agitation, irregular eye movements, and impaired consciousness. Patients with propofol neuroexcitation present unique challenges for anesthesia providers due to underrecognition, lack of diagnostic tests, and differentiating from other comparable disorders that require medications that can exacerbate symptoms. We present a case of a healthy young patient whose postoperative course was complicated by propofol frenzy and functional limb paralysis following hip surgery with a spinal anesthetic and propofol sedation. This case highlights anesthesia considerations for propofol frenzy and discusses dexmedetomidine as a promising modality for prompt management.

Osterc, Tea; Rupnik, Barbara; Rosskopf, Andrea B.; Borgeat, Alain; Eichenberger, Urs; Aguirre, José

doi: 10.1213/xaa.0000000000001572pmid: 35213408

An infraclavicular catheter is a very efficient technique to provide excellent perioperative anesthesia/analgesia for upper limb surgery. However, complications can occur and are dependent on the technique used. We report the inadvertent placement of an infraclavicular catheter in the interscalene region when an ultrasound-guided infraclavicular catheter was threaded cranially. We proposed some strategies to avoid the occurrence of complications when performing this block.

Nguyen, Jessica; Wang, Louie; Gomes, Fabiano A.; Delva, Nicholas J.

doi: 10.1213/xaa.0000000000001575pmid: 35302523

We report a case of a 72-year-old woman who experienced postictal episodes of trismus lasting several minutes on 6 occasions during a series of 18 episodes of electroconvulsive therapy (ECT). There was no clear relationship between the development of trismus and any medications used during the treatments. The patient had no adverse outcomes or discomfort, but the development of trismus can put patients at significant risk.

Salgado, Fernando; Douangpraseuth, Sounida; Dickerson, John R.; Crowley, John W.; Newton, Felecia A.

doi: 10.1213/xaa.0000000000001576pmid: 35324512

Headache after subarachnoid hemorrhage and corresponding craniotomy with aneurysm clipping can be severe and difficult to treat. Currently accepted analgesic therapies are often ineffective at treating the pain without incurring unacceptable side effects. We present an innovative approach wherein intravenous lidocaine infusions were used to successfully treat 2 patients with hyperalgesia refractory to traditional analgesic therapies. Opioid consumption fell to zero for both patients during lidocaine infusions without lidocaine toxicity. Moreover, after discontinuation of lidocaine infusions, both patients reported good pain control using only standard oral medications.

Seki, Hiroyuki; Watanabe, Hidenobu; Yorozu, Tomoko

doi: 10.1213/xaa.0000000000001570pmid: 35285818

Sodium-glucose cotransporter 2 (SGLT-2) inhibitors are relatively new antidiabetic drugs, which have been recently approved for heart failure treatment. Although treatment interruption is recommended 3 to 4 days before surgery, it is unclear whether SGLT-2 inhibitors should be discontinued when prescribed for heart failure treatment. We describe a case of postoperative ketoacidosis with hypoglycemia in an 83-year-old woman who took dapagliflozin for heart failure and underwent transcatheter aortic valve replacement. She was nondiabetic and took dapagliflozin on the day of the procedure. This case suggests the need to discontinue SGLT-2 inhibitors ahead of the day of surgery when used for heart failure.

Kikuchi, Masaru; Sawada, Mana; Nomura, Takeshi; Mizuno, Yusuke; Goto, Takahisa

doi: 10.1213/xaa.0000000000001577pmid: 35324514

We report a rare case in which a peripherally inserted central catheter (PICC) asymptomatically penetrated the median nerve. The patient was a 71-year-old man who displayed no neurological symptoms until 4 days after PICC placement. An ultrasound scan revealed that the PICC had penetrated the median nerve. He underwent surgery to remove the catheter and had no sequelae. When placing a PICC, selecting the brachial vein as a puncture site is associated with a high risk of nerve injury. Furthermore, circumspect observation is needed until withdrawal as neurological symptoms may be absent even when the catheter has punctured a nerve.

Saini, Kulbhushan; Singh, Avneet; Mishra, Anand Kumar; Gupta, Rekha; Walia, Sheenam; Negi, Sunder

doi: 10.1213/xaa.0000000000001573pmid: 35285820

Variations in the alveolar plateau phase of the capnogram are often confused with spontaneous breathing efforts in an intubated patient. The oscillations in the capnogram due to a large ascending thoracic aneurysm are a separate entity from cardiogenic oscillations, and can be an indicator of underlying bronchial or lung compression.

Chang, Brian A.; Bernstein, Kyra R.

doi: 10.1213/xaa.0000000000001571pmid: 35255016

Hyperekplexia is a rare genetic disorder characterized by an exaggerated startle response to innocuous stimuli. There are several case reports documenting the administration of general anesthesia to infants and children with hyperekplexia and 1 case report documenting the use of a labor epidural in a parturient. These cases suggest a possible resistance to depolarizing neuromuscular blocking agents and increased risk of malignant hyperthermia. There are no case reports of adults with hyperekplexia receiving general anesthesia. We report the case of a 20-year-old woman with hyperekplexia who safely received general anesthesia without neuromuscular blockade for a laparoscopic colectomy.

Havlik, Steven; Chino, Kumiko; Lebenson, Joshua; Cagniart, Pierre; Hamersley, Erin; Haldeman, Matthew

doi: 10.1213/xaa.0000000000001574pmid: 35324513

We reviewed a case of bilateral sphenopalatine ganglion (SPG) blockade with liposomal bupivacaine for sinus surgery. The case was complicated by severe postoperative hypertension refractory to antihypertensives and needing intensive care unit (ICU) admission. While SPG blockade has been used to treat headaches and provide perioperative analgesia, this complication and a possible mechanism have not been described. We discuss how local anesthetic spread beyond the SPG may have caused prolonged parasympathetic blockade and hypertension. Before approved indications are established, we recommend avoiding the use of liposomal bupivacaine in off-label settings when the function of bilateral autonomic structures could be affected.