Delayed diagnosis of butyrylcholinesterase deficiency with insufficient neuromuscular monitoring and a confounding effect of SedLine® brain function monitoring: a case report.

Intraoperative monitoring has always been a vital part of the care of an anaesthetised patient. Neuromuscular monitoring is important to use when patients have received neuromuscular blocking agents. Quantitative neuromuscular monitors are preferred over qualitative monitors and clinical judgement alone in reducing residual neuromuscular block and the associated respiratory complications.

Anesthetic Management of a Patient With McArdle Disease: A Case Report and Review of the Literature.

McArdle disease (glycogen storage disorder type V) is a rare inherited condition resulting in impaired energy metabolism. Challenges in anesthetized patients with McArdle disease include hypoglycemia, rhabdomyolysis, myoglobinuria, acute renal failure, and postoperative fatigue. We review the literature and discuss a successful anesthetic that had no perioperative complications for a patient with McArdle disease undergoing robotic-assisted lung wedge resection.

General Anesthesia With Successful Immediate Post-operative Extubation for Sarcoma Excision in a 61-Year-Old Male With Kennedy's Disease.

Kennedy's disease (KD), also known as spinal and bulbar muscular atrophy (SBMA), is a rare, X-linked recessive androgen receptor gene mutation affecting approximately one in 40,000 males. A prominent anesthetic concern in patients with KD is their ability to maintain a patent airway following general anesthesia. We present the case of a 61-year-old man with a history of KD presenting for a left thigh sarcoma excision.

Rupture of an epidural filter connector during bolus administration of local anesthetic: a case report.

Background: Epidural catheters are routinely placed for many surgical procedures and to treat various pain conditions. Known complications arising from epidural catheter equipment malfunction include epidural pump failure, epidural catheter shearing, epidural catheter connector failure, epidural filter connector cracking, and loss-of-resistance syringe malfunction. Practitioners need to be aware of these potentially dangerous complications and take measures to mitigate the chances of causing significant patient harm.

Use of a Low Concentration, High Volume Erector Spinae Plane Block for Rescue Analgesia After Melanoma Resection and Axillary Sentinel Lymph Node Biopsy.

The erector spinae plane block (ESPB), a recent innovation in regional anesthesia, has been used for analgesia of the thorax and chest. The case presented describes the use of an ESPB postoperatively for rescue analgesia on an elderly, opioid-naïve patient, who had severe postoperative pain after outpatient surgery at an axillary sentinel lymph node biopsy site refractory to escalating IV opioid doses. The rescue ESPB was successful in reducing the patient's pain to 0/10, allowing the patient to be discharged home and preventing a costly hospital admission.

Anaesthesia-specific checklists: A systematic review of impact.

Checklists are recognised as powerful tools to prevent avoidable errors in high-reliability organisations. In healthcare, the perioperative area has been a leading field in the development of a wide range of checklists. However, clinical literature on this subject is still sparse and heterogeneous, producing results that are sometimes conflicting.

Intraoperative Goal-Directed Anesthetic Management of the Patient with Severe Pulmonary Hypertension.

BACKGROUND It is very challenging for anesthesiologists to manage patients with pulmonary hypertension undergoing general anesthesia for elective or emergent surgeries. CASE REPORT We present a patient with severe pulmonary hypertension going through a major robotic thoracic surgery. CONCLUSIONS A goal-directed anesthesia management algorithm based on serial stroke volume (SV) values obtained from FloTrac (Edwards Lifesciences, LLC.

Gradual withdrawal of remifentanil delays initial post-operative analgesic demand after thyroid surgery; double-blinded, randomized controlled trial.

Background: Mismanagement of remifentanil leads to severe side effects such as opioid-induced tolerance and hyperalgesia. Recently studies revealed an alternative withdrawal method to limit these side effects. A gradual withdrawal of remifentanil seems to be associated with less pain.