Post-Dural Puncture Headache is a common complication for patients with dural puncture and if untreated, it can result in complications such as subdural hematoma and seizures. The aim of this case report is to present a case of headache after corrective spinal surgery for idiopathic scoliosis resolved with a BGON block.

Background & Aims: An experience feedback committee (EFC) is a management method for patient safety designed for a medical team. The aim of this study was to analyse the functioning of an EFC in an anaesthesia department and to explore its contribution to patient safety. Method: We conducted a descriptive study based on all the written documents produced by the EFC between October 2009 and September 2011.

Lung isolation management has long been a complicated issue in the neonatal patient due to the patient’s size which limits the ability to use many of the devices used in the adult patient. The Arndt bronchial blocker is now available in sizes that allow lung isolation to be feasible in the pediatric patient. Traditionally, use of the Arndt bronchial blocker has been limited to short term use in the operating room. This case report discusses the use of the Arndt bronchial blocker for an extended period of time in the Cardiac Intensive Care Unit (CICU) to successfully treat multiple unilateral pneumatoceles in a neonate and in the process avoid the use of Extracorporeal Membrane Oxygenation (ECMO) and its associated risks. It also describes the use of radiocontrast dye in the bronchial blocker cuff in order to facilitate identification of cuff position by subsequent chest xrays.

Ketamine is a dissociative anesthetic that is frequently used for the induction and maintenance of general anesthesia in children. It has been reported that blockade of NMDA receptors by ketamine may cause neurotoxicity in neonatal rats when given over a 12 hour period during the brain growth spurt. Noninvasive, quantitative imaging of rodent brains may allow for the detection of functional, morphological and metabolic alterations induced by ketamine. Since it is known that level of the mitochondrial translocator protein (TSPO), formerly known as the peripheral benzodiazepine receptor (PBR) increase in areas of neuronal injury following exposure to neurotoxicants, TSPOs are widely recognized as important targets for imaging using positron emission tomography (PET). In this study, the effect of ketamine on the uptake and retention of [18F]-FEPPA (a TSPO ligand) in the brains of rats and the potential protective effect of minocycline, an anti-infl ammatory agent, on anesthetic-induced neuronal cell death were investigated using microPET/CT imaging. On postnatal day 7 (PND 7), rat pups in the experimental group were exposed to 6 injections of ketamine (20 mg/kg at 2 h intervals) with or without minocycline (45mg/ kg i.p. 30 minutes prior to, and 4 hours after exposure); control pups received 6 injections of saline. On PNDs 14, 21, 28 and 35, [18F]-FEPPA (18.5 MBq) was injected into the tail vein of treated and control rats and microPET/CT images were obtained over the next 90 minutes. Radiolabeled tracer accumulation in regions of interest (ROIs) in the frontal cortex was converted into Standard Uptake Values (SUVs). In PND 14 and 21 rats the uptake of [18F]-FEPPA was signifi cantly increased and the duration of tracer wash-out was prolonged in ketamine-treated rats. The increased uptake of the tracer was attenuated by the co-administration of minocycline. As expected, no signifi cant difference in radiotracer uptake in the frontal cortex was observed at 28 or 35 days after anesthesia. This preliminary study demonstrates that microPET imaging is capable of distinguishing differences in retention of [18F] -FEPPA in the brains of rodents and suggests that this approach may provide a minimally-invasive biomarker of pathogenic process associated with neurotoxicity induced by ketamine. Minocycline effectively blocks the neuronal injury caused by ketamine anesthesia in the developing rat brain.

Subclavian artery stenosis (SAS) is a relatively rare condition, even more so for its bilateral existence. In a study [1], the prevalence of SAS was 1.9% in the free-living cohorts and 7.1% in the clinical cohorts. SAS was significantly associated with smoking and higher levels of systolic blood pressure. Higher levels of high-density lipoprotein cholesterol were inversely and signifi cantly associated with SAS. In regression analyses relating SAS to other cardiovascular diseases, the only significant finding was with peripheral arterial disease. The presence of this condition leads to erroneously low blood pressure recoded in the ipsilateral brachial artery or radial artery. The conventional anaesthetic challenge for these patients could be maintaining organ perfusion (especially the cerebral perfusion) and thus avoiding ischaemic damage when the actual blood pressure is unknown. We report an interesting patient with bilateral subclavian stenosis who underwent prolonged surgery for a repair of massive parastomal hernia. This case was detected incidentally based on clinical findings. It was confirmed subsequently by CT angiogram. The surgery was performed under general anaesthesia and the patient was discharged home unharmed.

Purpose: Knee arthroscopy is one of the most frequent procedures in orthopedic surgery. It has a large range of indications. Post-operative pain is one complication and it is managed with analgesics sometimes with weak opioids. It has been proven that auriculotherapy is effi cient in decreasing post-operative pain for many orthopedic surgeries, in particular knee and hip arthroplasty. We studied the interest of auriculotherapy for post-operative pain after knee arthroscopy.

This case report revealed that Raynaud’s phenomenon happened during anesthesia recovery period and caused panic. We performed general anesthesia for a patient who underwent laparoscopic nephrectomy and denied any signifi cant medical history. After surgery, just when the patient started breathing, we noticed that the displayed waveform and numerical values of SpO2 disappeared suddenly. No problems were detected in the monitor and the ventilator. On auscultation, both lungs were being ventilated well. Severe complications were suspected which led to tense and panic. The patient was extubated later, and she confirmed that she had primary Raynaud’s for 6 years. The patient was transferred to the recovery room later, and then her ward uneventfully. It is important to know the whole medical history of patients’. The attack of Raynaud’s phenomenon can make the displayed waveform and numerical values of SpO2 disappear suddenly.

Study Objective: Our hypothesis is that systemic lidocaine can significantly reduce chronic pain associated with fibromyalgia. A secondary goal of the study is to determine if other patient demographics can affect the response to IV lidocaine. Design: Retrospective chart review Setting: Outpatient pain clinic Patients: 55 patients being treated for fibromyalgia by lidocaine infusion Interventions: Intravenous infusion of lidocaine 5mg/kg over 1 hour Measurements: Two-tailed paired t-tests (a=0.05) were performed to test for significant change from pre- to post-infusion in BPI, PI, and VAS scores. Smoking status and race classification were also identified.

Modern day general anesthesia has a convincing safety record in any age group presenting with or without severe co-morbidities, hence allowing surgeons to introduce a broad range of patients to surgical procedures. However, sometimes patients present with the most signifi cant co-morbidities and organ function impairment where then general anesthesia becomes a major risk in itself. Awake surgery under regional/neuroaxial anesthesia is a possible alternative in chosen cases and has been described in cardiac and lower abdominal surgery.