S. Muangman, M. Raksakietisak, P. Akavipat, P. Rushatamukayanunt, Sirinuttakul Akkaworakit, Natthaporn Romkespikun, Porntip Mahatnirunkul
Abstract Background Dexmedetomidine, an alpha-2 agonist, has been widely used as an anesthetic adjunct for transsphenoidal pituitary resection. However, there is no consensus on the appropriate infusion dosage. This study aimed to compare the effects of low (0.2 mcg/kg/h) and intermediate (0.5 mcg/kg/h) dexmedetomidine infusions during anesthetic maintenance on blood loss, hemodynamics, and operating time. Methods A randomized controlled trial involving two centers was conducted. Between December 2015 and November 2019, 80 patients (40 in each group) who underwent elective transsphenoidal pituitary tumor resection were recruited. Dexmedetomidine was administered to group I at a loading dose of 0.5 mcg / kg, followed by 0.2 mcg / kg / h, and to group II at the same loading dose, followed by 0.5 mcg / kg / h. Comparative analyses were performed using the Student's t -test, repeated-measures analysis of variance, and Mann–Whitney U test; p -values < 0.05 were considered statistically significant. Results Eighty patients were analyzed. Patient demographics were comparable. The difference in intraoperative blood loss between both groups (320 [220–525] vs. 250 [100-487] mL, p = 0.070) was not statistically significant. There were no differences in blood pressure or heart rate between the groups. In group II, the procedure took significantly less time (179 vs. 142 minutes, p = 0.018), with more episodes of transient hypotension ( p = 0.034). Conclusion When maintaining anesthesia for transsphenoidal pituitary resection, dexmedetomidine infusions of 0.2 and 0.5 mcg / kg / h showed the same effect on blood loss and hemodynamics; however, significantly more episodes of transient hypotension and shorter operating times were noted with the latter.
{"title":"Effects of Low versus Intermediate Doses of Dexmedetomidine Infusion on Blood Loss, Hemodynamics, and Operative Time in Transsphenoidal Pituitary Tumor Removal: A Prospective Randomized Study","authors":"S. Muangman, M. Raksakietisak, P. Akavipat, P. Rushatamukayanunt, Sirinuttakul Akkaworakit, Natthaporn Romkespikun, Porntip Mahatnirunkul","doi":"10.1055/s-0042-1758747","DOIUrl":"https://doi.org/10.1055/s-0042-1758747","url":null,"abstract":"Abstract Background Dexmedetomidine, an alpha-2 agonist, has been widely used as an anesthetic adjunct for transsphenoidal pituitary resection. However, there is no consensus on the appropriate infusion dosage. This study aimed to compare the effects of low (0.2 mcg/kg/h) and intermediate (0.5 mcg/kg/h) dexmedetomidine infusions during anesthetic maintenance on blood loss, hemodynamics, and operating time. Methods A randomized controlled trial involving two centers was conducted. Between December 2015 and November 2019, 80 patients (40 in each group) who underwent elective transsphenoidal pituitary tumor resection were recruited. Dexmedetomidine was administered to group I at a loading dose of 0.5 mcg / kg, followed by 0.2 mcg / kg / h, and to group II at the same loading dose, followed by 0.5 mcg / kg / h. Comparative analyses were performed using the Student's t -test, repeated-measures analysis of variance, and Mann–Whitney U test; p -values < 0.05 were considered statistically significant. Results Eighty patients were analyzed. Patient demographics were comparable. The difference in intraoperative blood loss between both groups (320 [220–525] vs. 250 [100-487] mL, p = 0.070) was not statistically significant. There were no differences in blood pressure or heart rate between the groups. In group II, the procedure took significantly less time (179 vs. 142 minutes, p = 0.018), with more episodes of transient hypotension ( p = 0.034). Conclusion When maintaining anesthesia for transsphenoidal pituitary resection, dexmedetomidine infusions of 0.2 and 0.5 mcg / kg / h showed the same effect on blood loss and hemodynamics; however, significantly more episodes of transient hypotension and shorter operating times were noted with the latter.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"10 1","pages":"039 - 045"},"PeriodicalIF":0.0,"publicationDate":"2023-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45704307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract This case report describes a young patient with no comorbidities, who presented with two systemic thrombotic events within 24 hours of admission. She presented with a right middle cerebral artery territory infarct and developed an inferior wall myocardial infarction soon after. The hypotension was refractory to inotropes and required emergency intra-aortic balloon pump insertion. She was evaluated for prothrombotic states and other causes of stroke in young. However, the workup for the same was negative. Coronavirus disease-2019 immunoglobulin G antibody titer and inflammatory markers were found to be extremely elevated, which suggested recent severe infection. This case report throws light on the multidisciplinary management of thrombotic events, most probably secondary to coronavirus infection.
{"title":"Successful Treatment of a COVID 19-Associated Multisystem Thrombotic Event in a Young Patient in a Neurocritical Care Unit","authors":"Geetha Lakshminarasimhaiah, Ridhi Rao","doi":"10.1055/s-0042-1758489","DOIUrl":"https://doi.org/10.1055/s-0042-1758489","url":null,"abstract":"Abstract This case report describes a young patient with no comorbidities, who presented with two systemic thrombotic events within 24 hours of admission. She presented with a right middle cerebral artery territory infarct and developed an inferior wall myocardial infarction soon after. The hypotension was refractory to inotropes and required emergency intra-aortic balloon pump insertion. She was evaluated for prothrombotic states and other causes of stroke in young. However, the workup for the same was negative. Coronavirus disease-2019 immunoglobulin G antibody titer and inflammatory markers were found to be extremely elevated, which suggested recent severe infection. This case report throws light on the multidisciplinary management of thrombotic events, most probably secondary to coronavirus infection.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"10 1","pages":"060 - 062"},"PeriodicalIF":0.0,"publicationDate":"2023-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45865043","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
R. Mariappan, Rebecca A. Ninan, Krishnaprabhu Raju
Abstract A 6-month-old infant presented with clinicoradiological features of a shunt dysfunction. Magnetic resonance imaging brain showed multiple leptomeningeal cysts in the posterior fossa, with the largest in the right cerebellopontine (CP) angle cistern causing compression on the brain stem and fourth ventricle. There was gross hydrocephalus with the malpositioned shunt tube. He underwent shunt revision followed by right retromastoid craniectomy and decompression of the right CP angle cyst. Following extubation, he developed stridor that was diagnosed initially as subglottic edema and treated with humidified oxygen, systemic corticosteroids, and nebulized adrenaline. Failure to resolve the symptoms warranted a video laryngoscopy that revealed right vocal cord palsy (VCP), and he was reintubated. He was started on steroids and got extubated on a nasal continuous positive airway pressure and was gradually weaned off. Intraoperative handling of the vagus nerve while decompressing the cyst led to a right VCP, which was communicated later to the anesthesiologist. Neurological cause and association need to be considered as one of the differentials while managing postoperative stridor after posterior fossa surgery in an infant. Timely communication between the surgeon and anesthesiologist is paramount for reducing morbidity.
{"title":"Not All Postoperative Stridor in Infants Is Due to Endotracheal Tube-Induced Subglottic Edema","authors":"R. Mariappan, Rebecca A. Ninan, Krishnaprabhu Raju","doi":"10.1055/s-0042-1758748","DOIUrl":"https://doi.org/10.1055/s-0042-1758748","url":null,"abstract":"Abstract A 6-month-old infant presented with clinicoradiological features of a shunt dysfunction. Magnetic resonance imaging brain showed multiple leptomeningeal cysts in the posterior fossa, with the largest in the right cerebellopontine (CP) angle cistern causing compression on the brain stem and fourth ventricle. There was gross hydrocephalus with the malpositioned shunt tube. He underwent shunt revision followed by right retromastoid craniectomy and decompression of the right CP angle cyst. Following extubation, he developed stridor that was diagnosed initially as subglottic edema and treated with humidified oxygen, systemic corticosteroids, and nebulized adrenaline. Failure to resolve the symptoms warranted a video laryngoscopy that revealed right vocal cord palsy (VCP), and he was reintubated. He was started on steroids and got extubated on a nasal continuous positive airway pressure and was gradually weaned off. Intraoperative handling of the vagus nerve while decompressing the cyst led to a right VCP, which was communicated later to the anesthesiologist. Neurological cause and association need to be considered as one of the differentials while managing postoperative stridor after posterior fossa surgery in an infant. Timely communication between the surgeon and anesthesiologist is paramount for reducing morbidity.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"10 1","pages":"063 - 065"},"PeriodicalIF":0.0,"publicationDate":"2023-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45114976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract A cerebral abscess can be a life-threatening complication of pulmonary arteriovenous malformations (PAVM), thus posing significant morbidity if left untreated. We report a case of an incidental finding of a PAVM in a patient diagnosed with cerebral abscess. A 22-year-old male presented to the emergency department with acute onset right-sided weakness in both upper and lower limbs for 1 week. Magnetic resonance imaging showed a ring-enhancing lesion within the left parasagittal frontoparietal region s/o intracerebral abscess. High-resolution computed tomography was done as a protocol in patients posted for surgery due to coronavirus disease 2019 and coincidentally, it showed a single well-defined parenchymal nodule, 4 × 3.4 cm in the lateral basal segment of the left lower lobe. The knowledge of the pathophysiology of PAVM and expected complications during general anesthesia (GA) and positive pressure mechanical ventilation is essential. In such conditions, awake craniotomy under conscious sedation and scalp block may be considered as an alternative to GA.
{"title":"Awake Craniotomy for Cerebral Abscess with Pulmonary Arteriovenous Malformation","authors":"Saloni Shah, A. Shetty, Dhairal Mehta","doi":"10.1055/s-0042-1756432","DOIUrl":"https://doi.org/10.1055/s-0042-1756432","url":null,"abstract":"Abstract A cerebral abscess can be a life-threatening complication of pulmonary arteriovenous malformations (PAVM), thus posing significant morbidity if left untreated. We report a case of an incidental finding of a PAVM in a patient diagnosed with cerebral abscess. A 22-year-old male presented to the emergency department with acute onset right-sided weakness in both upper and lower limbs for 1 week. Magnetic resonance imaging showed a ring-enhancing lesion within the left parasagittal frontoparietal region s/o intracerebral abscess. High-resolution computed tomography was done as a protocol in patients posted for surgery due to coronavirus disease 2019 and coincidentally, it showed a single well-defined parenchymal nodule, 4 × 3.4 cm in the lateral basal segment of the left lower lobe. The knowledge of the pathophysiology of PAVM and expected complications during general anesthesia (GA) and positive pressure mechanical ventilation is essential. In such conditions, awake craniotomy under conscious sedation and scalp block may be considered as an alternative to GA.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-12-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46172902","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract Transesophageal echocardiography (TEE) is a commonly used diagnostic and monitoring modality in anesthetic practice. It is used in neurosurgery for monitoring cardiac function and detecting venous air embolism. TEE is a semi-invasive procedure and is considered to be reasonably safe with a few complications. During neurosurgical cases, access to the head end is limited and TEE can cause injury due to prolonged contact. These injuries can be noticed only at the conclusion of the surgery. We report a rare case of tongue ulcer caused due to the use of TEE in a sitting neurosurgical procedure with a complete resolution.
{"title":"A Rare Case of Transesophageal Echocardiography Probe-Induced Tongue Ulcer","authors":"Sanjay Surwade, R. Chelani, Manju Butani","doi":"10.1055/s-0042-1757169","DOIUrl":"https://doi.org/10.1055/s-0042-1757169","url":null,"abstract":"Abstract Transesophageal echocardiography (TEE) is a commonly used diagnostic and monitoring modality in anesthetic practice. It is used in neurosurgery for monitoring cardiac function and detecting venous air embolism. TEE is a semi-invasive procedure and is considered to be reasonably safe with a few complications. During neurosurgical cases, access to the head end is limited and TEE can cause injury due to prolonged contact. These injuries can be noticed only at the conclusion of the surgery. We report a rare case of tongue ulcer caused due to the use of TEE in a sitting neurosurgical procedure with a complete resolution.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"10 1","pages":"054 - 055"},"PeriodicalIF":0.0,"publicationDate":"2022-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45398754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Kodan, R. Aggarwal, Rakesh Kumar, Satyendra Nawal
There is growing interest on coronavirus disease 2019 (COVID-19)-associated neurological manifestations and the interplay of COVID-19 in patients with existing neurological illness.1 We wish to share our rare case of COVID-19-associated neurological manifestations in a patient with amyotrophic lateral sclerosis (ALS). ALS is a neurodegenerative disease with very scarce information suggesting how COVID-19 affects patients with ALS.2,3 Case reports of COVID-19 in ALS are handful in literature and none of them highlights the acute deterioration in respiratory status with acute COVID-19 and the subsequent complications of long COVID-19. To the best of our knowledge, this is the first such reported case.
{"title":"A Rare Case of Severe Long COVID-19 in Patient with Amyotrophic Lateral Sclerosis","authors":"P. Kodan, R. Aggarwal, Rakesh Kumar, Satyendra Nawal","doi":"10.1055/s-0042-1755366","DOIUrl":"https://doi.org/10.1055/s-0042-1755366","url":null,"abstract":"There is growing interest on coronavirus disease 2019 (COVID-19)-associated neurological manifestations and the interplay of COVID-19 in patients with existing neurological illness.1 We wish to share our rare case of COVID-19-associated neurological manifestations in a patient with amyotrophic lateral sclerosis (ALS). ALS is a neurodegenerative disease with very scarce information suggesting how COVID-19 affects patients with ALS.2,3 Case reports of COVID-19 in ALS are handful in literature and none of them highlights the acute deterioration in respiratory status with acute COVID-19 and the subsequent complications of long COVID-19. To the best of our knowledge, this is the first such reported case.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"09 1","pages":"207 - 208"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49128397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
C. Nagaraj, R. Joshi, Dinesh G. Kumar, G. R, D. Chakrabarti, P. Singh, Sandhya Mangalore, Ramesh J. Venkatapura
Abstract This observational study was conducted owing to the challenges of the positron emission tomography/magnetic resonance imaging (PET/MRI) that requires longer duration scanning of radiopharmaceutical injected patient and added MRI environment. The aim of this study was to assess radiation dose at different distances from the patient and the radiation burden to anesthesiologist and other personnel in performing PET/MRI under general anesthesia or sedation. First, the pre- and postscan whole body radiation exposure (WBE) from the patient were obtained for 45 minutes ( n = 109) after injection of the radiopharmaceutical. The WBE was obtained at specific distances from brain (10, 30, and 100 cm) and abdomen (10 and 30cm) of patients undergoing F18 fluorodeoxyglucose PET/MRI brain or whole body studies. Second, WBE of the anesthesiologist and other staff working was separately measured using pocket dosimeters during the whole procedure. In brain scans, the mean absorbed dose rates (ADR) of prescan (45 minutes) and postscan (45 minutes) were 44.4 and 31.1 μSv at 10 cm, 14.9 and 9.7μSv at 30 cm, and 3.5 and 2.8 μSv at 100 cm, respectively, from surface of head. Similarly, it was 54.8 and 30.3 μSv at 10 cm, 23 and 13.6μSv at 30 cm, respectively, from surface of abdomen. In WB scans, the mean ADR was higher than the brain scans. Anesthesiologist exposure overall was found to be 4.84 µSv/patient/scan (112 patients). The anesthesiologist receives a safe mean effective dose in PET/MRI scanning. With good training and adequate planning, it is possible to decrease the radiation exposure to all the concerned personnel including anesthesiologists.
{"title":"Radiation Safety for Anesthesiologists and Other Personnel on Simultaneous PET/MRI: Possible Radiation Exposure from Patients While Performing Prolonged Duration Scans","authors":"C. Nagaraj, R. Joshi, Dinesh G. Kumar, G. R, D. Chakrabarti, P. Singh, Sandhya Mangalore, Ramesh J. Venkatapura","doi":"10.1055/s-0042-1750710","DOIUrl":"https://doi.org/10.1055/s-0042-1750710","url":null,"abstract":"Abstract This observational study was conducted owing to the challenges of the positron emission tomography/magnetic resonance imaging (PET/MRI) that requires longer duration scanning of radiopharmaceutical injected patient and added MRI environment. The aim of this study was to assess radiation dose at different distances from the patient and the radiation burden to anesthesiologist and other personnel in performing PET/MRI under general anesthesia or sedation. First, the pre- and postscan whole body radiation exposure (WBE) from the patient were obtained for 45 minutes ( n = 109) after injection of the radiopharmaceutical. The WBE was obtained at specific distances from brain (10, 30, and 100 cm) and abdomen (10 and 30cm) of patients undergoing F18 fluorodeoxyglucose PET/MRI brain or whole body studies. Second, WBE of the anesthesiologist and other staff working was separately measured using pocket dosimeters during the whole procedure. In brain scans, the mean absorbed dose rates (ADR) of prescan (45 minutes) and postscan (45 minutes) were 44.4 and 31.1 μSv at 10 cm, 14.9 and 9.7μSv at 30 cm, and 3.5 and 2.8 μSv at 100 cm, respectively, from surface of head. Similarly, it was 54.8 and 30.3 μSv at 10 cm, 23 and 13.6μSv at 30 cm, respectively, from surface of abdomen. In WB scans, the mean ADR was higher than the brain scans. Anesthesiologist exposure overall was found to be 4.84 µSv/patient/scan (112 patients). The anesthesiologist receives a safe mean effective dose in PET/MRI scanning. With good training and adequate planning, it is possible to decrease the radiation exposure to all the concerned personnel including anesthesiologists.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"09 1","pages":"162 - 167"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41466130","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Y. M. Gali, Lakshman K. Kommula, Subba R. Kesavarapu, S. Gurrala
Abstract Pneumocephalus is a serious complication following brain trauma. Tension pneumocephalus (TP) is entrapment of a large volume of air in the cranial vault causing mass effect on the brain parenchyma. It is the intracranial counterpart of tension pneumothorax and if neglected, can be life threatening. TP should be timely differentiated from benign pneumocephalus owing to its various nonspecific and lethal complications. Our patient is a 37-year-old male with a history of road traffic accident who presented to our hospital with headache and nasal discharge for the last two days. Computed tomography showed multiple skull fractures and extensive pneumocephalus. His preoperative heart rate was 38 beats per minute that was resistant to pharmacological interventions and required a temporary pacemaker for surgery. He underwent uneventful craniotomy for dura repair and was discharged home with no neurological deficit.
{"title":"Posttraumatic Tension Pneumocephalus Causing Atropine-Resistant Bradycardia","authors":"Y. M. Gali, Lakshman K. Kommula, Subba R. Kesavarapu, S. Gurrala","doi":"10.1055/s-0042-1751091","DOIUrl":"https://doi.org/10.1055/s-0042-1751091","url":null,"abstract":"Abstract Pneumocephalus is a serious complication following brain trauma. Tension pneumocephalus (TP) is entrapment of a large volume of air in the cranial vault causing mass effect on the brain parenchyma. It is the intracranial counterpart of tension pneumothorax and if neglected, can be life threatening. TP should be timely differentiated from benign pneumocephalus owing to its various nonspecific and lethal complications. Our patient is a 37-year-old male with a history of road traffic accident who presented to our hospital with headache and nasal discharge for the last two days. Computed tomography showed multiple skull fractures and extensive pneumocephalus. His preoperative heart rate was 38 beats per minute that was resistant to pharmacological interventions and required a temporary pacemaker for surgery. He underwent uneventful craniotomy for dura repair and was discharged home with no neurological deficit.","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"09 1","pages":"204 - 206"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44373565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Balaji Vaithialingam, Mouleeswaran Sundaram, V. Bhadrinarayan
Horner ’ s syndrome is a rare phenomenon associated with a wide variety of medical and surgical conditions. Ipsilateral ptosis and miosis occur in Horner ’ s syndrome due to the sympathetic disruption at any point along the pathway from the posterolateral hypothalamus to the cervical sympathetic trunk. 1 It is awell-recognized but infrequententity following cervical spine instrumentation through the anterior approach with an incidence ranging from 0.02% to 3.8% during the anterior cervical discectomy and fusion (ACDF) proce-dure. 2,3 We report a rare case of transient Horner ’ ssyndrome following posterior cervical spine instrumentation for congenital atlantoaxial dislocation (AAD). A 13-year-old male patient presented with neck pain and weakness in all four limbs for the past 6 months. Neurologi-cal examination revealed a motor power of grade 3 in all four limbs with a normal pupillary size and reactivity. A diagnosis of reducible AAD was considered based on the dynamic computed tomographic (CT) imaging without radiological evidence of basilar invagination or Arnold Chiari malforma-tion. The patient was planned for C1-C2 fusion under general anesthesia in the prone position. After induction of anesthesia, the patient was placed in the prone position, the head was fi xed with the May fi eld clamp, and the eyes were
{"title":"Transient Horner's Syndrome following Posterior Cervical Spine Instrumentation: A Postoperative Dilemma","authors":"Balaji Vaithialingam, Mouleeswaran Sundaram, V. Bhadrinarayan","doi":"10.1055/s-0042-1757170","DOIUrl":"https://doi.org/10.1055/s-0042-1757170","url":null,"abstract":"Horner ’ s syndrome is a rare phenomenon associated with a wide variety of medical and surgical conditions. Ipsilateral ptosis and miosis occur in Horner ’ s syndrome due to the sympathetic disruption at any point along the pathway from the posterolateral hypothalamus to the cervical sympathetic trunk. 1 It is awell-recognized but infrequententity following cervical spine instrumentation through the anterior approach with an incidence ranging from 0.02% to 3.8% during the anterior cervical discectomy and fusion (ACDF) proce-dure. 2,3 We report a rare case of transient Horner ’ ssyndrome following posterior cervical spine instrumentation for congenital atlantoaxial dislocation (AAD). A 13-year-old male patient presented with neck pain and weakness in all four limbs for the past 6 months. Neurologi-cal examination revealed a motor power of grade 3 in all four limbs with a normal pupillary size and reactivity. A diagnosis of reducible AAD was considered based on the dynamic computed tomographic (CT) imaging without radiological evidence of basilar invagination or Arnold Chiari malforma-tion. The patient was planned for C1-C2 fusion under general anesthesia in the prone position. After induction of anesthesia, the patient was placed in the prone position, the head was fi xed with the May fi eld clamp, and the eyes were","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"09 1","pages":"213 - 214"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45067131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Mukilan Balasubramanian, Ankita Dey, Rajasekar Ramadurai, A. Kuberan
Microscope-integrated indocyanine green video angiography (ICG-VA) is used to assess the completeness of clipping and cerebral vascular fl ow during aneurysm surgery. 1 It is a more practical and less time-consuming alternative to intraoperative digital subtraction angiography (DSA). ICG has been reported to cause a decrease in peripheral oxygen saturation (SpO 2 ). 2 – 4 We report a 48-year-old male who presented with complaints of holocranial throbbing headache for 1 month without any history of seizures or focal neurological de fi cit. The patient was a known alcoholic for the past 20 years. Liver function test showed hyperbilirubinemia and elevat-ed serum transaminases. Noncontrast computed tomogra-phy brain revealed subarachnoid hemorrhage. The patient was found to have two aneurysms in the anterior cerebral circulation, one in the anterior communicating artery and one in the right M1 middle cerebral artery, on a DSA scan. He was scheduled for a craniotomy and clipping of both aneurysms. ICG (Aurogreen, Aurolab, Madurai, Tamil Nadu, India) at a dose of 0.25mg/kg
{"title":"Indocyanine Green Administration May Cause an Exaggerated Peripheral Oxygen Desaturation in the Presence of Liver Disease—An Underemphasized Observation","authors":"Mukilan Balasubramanian, Ankita Dey, Rajasekar Ramadurai, A. Kuberan","doi":"10.1055/s-0042-1760270","DOIUrl":"https://doi.org/10.1055/s-0042-1760270","url":null,"abstract":"Microscope-integrated indocyanine green video angiography (ICG-VA) is used to assess the completeness of clipping and cerebral vascular fl ow during aneurysm surgery. 1 It is a more practical and less time-consuming alternative to intraoperative digital subtraction angiography (DSA). ICG has been reported to cause a decrease in peripheral oxygen saturation (SpO 2 ). 2 – 4 We report a 48-year-old male who presented with complaints of holocranial throbbing headache for 1 month without any history of seizures or focal neurological de fi cit. The patient was a known alcoholic for the past 20 years. Liver function test showed hyperbilirubinemia and elevat-ed serum transaminases. Noncontrast computed tomogra-phy brain revealed subarachnoid hemorrhage. The patient was found to have two aneurysms in the anterior cerebral circulation, one in the anterior communicating artery and one in the right M1 middle cerebral artery, on a DSA scan. He was scheduled for a craniotomy and clipping of both aneurysms. ICG (Aurogreen, Aurolab, Madurai, Tamil Nadu, India) at a dose of 0.25mg/kg","PeriodicalId":16574,"journal":{"name":"Journal of Neuroanaesthesiology and Critical Care","volume":"09 1","pages":"215 - 216"},"PeriodicalIF":0.0,"publicationDate":"2022-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48460501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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