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Novel presentations, rare complications and educational content: cases in clinical practice

Novel presentations, rare complications and educational content: cases in clinical practice Despite the lauded safety of our profession, critical events do still occur, even during relatively common procedures. Although not life‐threatening, failure of neuraxial anaesthesia is a complication that can be incredibly distressing to patients [1]. Wloch et al. report the case of a patient with Ehlers‐Danlos, who exhibited profound resistance to intrathecal bupivacaine anaesthesia for caesarean delivery [2]. Although resistance to local anaesthetics has been reported in the Ehlers‐Danlos population, there is significant phenotypic variation and there are currently no guidelines for the obstetric anaesthetic management of these patients. This report suggests that even with an intrathecally placed catheter, surgical anaesthesia cannot be guaranteed.A more feared complication of neuraxial anaesthesia is bleeding, particularly in coagulopathic or anticoagulated patients. Olivei et al. remind us that even in the absence of altered coagulation, clinically significant bleeding is possible during apparently atraumatic spinal injection [3]. They report a subarachnoid haemorrhage of possible lumbo‐spinal origin, which resulted in a transient flaccid paraplegia that spontaneously and completely resolved within hours. The authors included magnetic resonance imaging demonstrating both lumbar and cranial subarachnoid intensities. More than 300,000 spinal anaesthetics are performed each year in the UK alone, and the vast majority are without complication [4]. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Anaesthesia Reports Wiley

Novel presentations, rare complications and educational content: cases in clinical practice

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Publisher
Wiley
Copyright
2020 © Association of Anaesthetists
eISSN
2637-3726
DOI
10.1002/anr3.12056
Publisher site
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Abstract

Despite the lauded safety of our profession, critical events do still occur, even during relatively common procedures. Although not life‐threatening, failure of neuraxial anaesthesia is a complication that can be incredibly distressing to patients [1]. Wloch et al. report the case of a patient with Ehlers‐Danlos, who exhibited profound resistance to intrathecal bupivacaine anaesthesia for caesarean delivery [2]. Although resistance to local anaesthetics has been reported in the Ehlers‐Danlos population, there is significant phenotypic variation and there are currently no guidelines for the obstetric anaesthetic management of these patients. This report suggests that even with an intrathecally placed catheter, surgical anaesthesia cannot be guaranteed.A more feared complication of neuraxial anaesthesia is bleeding, particularly in coagulopathic or anticoagulated patients. Olivei et al. remind us that even in the absence of altered coagulation, clinically significant bleeding is possible during apparently atraumatic spinal injection [3]. They report a subarachnoid haemorrhage of possible lumbo‐spinal origin, which resulted in a transient flaccid paraplegia that spontaneously and completely resolved within hours. The authors included magnetic resonance imaging demonstrating both lumbar and cranial subarachnoid intensities. More than 300,000 spinal anaesthetics are performed each year in the UK alone, and the vast majority are without complication [4].

Journal

Anaesthesia Reports – Wiley

Published: Jul 1, 2020

Keywords: airway management; case reports; complications; critical incidents

References

  • Safety guideline: neurological monitoring associated with obstetric neuraxial block 2020
    Yentis, SM; Lucas, DN; Brigante, L
  • Local anaesthetic resistance in a patient with Ehlers‐Danlos syndrome undergoing caesarean section with continuous spinal anaesthesia
    Wloch, K; Simpson, M; Gowrie‐Mohan, S
  • Transient paraplegia due to subarachnoid haemorrhage following spinal anaesthesia
    Olivei, M; Tamanti, P; Giachetti, A; Nespoli, P; Berta, G; Caironi, P
  • Major complications of central neuraxial block: report on the Third National Audit Project of the Royal College of Anaesthetists
    Cook, TM; Counsell, D; Wildsmith, JAW
  • Pneumothorax following serratus anterior plane block
    Desai, M; Narayanan, MK; Venkataraju, A
  • Intra‐abdominal placement of nasogastric tube following inadvertent nasopharyngeal perforation
    Walmsley, C; Comben, E
  • Compartment syndrome of the hand as a complication of prolonged mechanical cardiopulmonary resuscitation
    Lesser, FD; Yakubi, M; Rochester, S; Evans, J; Highgate, J
  • Complications of anaesthesia
    Merry, AF; Mitchell, SJ
  • Postoperative hemiparesis due to conversion disorder after moderate sedation: a case report
    Jotwani, R; Turnbull, ZA
  • Three‐dimensional echocardiography to confirm persistent intracardiac air bubbles after mitral valve surgery
    Duncan, KC; Grocott, HP
  • Intra‐oral ignition of monopolar diathermy during transnasal humidified rapid‐insufflation ventilatory exchange (THRIVE)
    Onwochei, D; El‐Boghdadly, K; Oakley, R; Ahmad, I
  • Airway fire due to diathermy during tracheostomy in an intensive care patient
    Rogers, SA; Mills, KG; Tufail, Z
  • Airway fire during awake tracheostomy using high‐flow nasal oxygen
    Adams, TRP; Ricciardelli, A
  • Local anaesthetic toxicity during an awake tracheal intubation course
    Pearson, F; Chiam, P
  • Difficult Airway Society guidelines for awake tracheal intubation (ATI) in adults
    Ahmad, I; El‐Boghdadly, K; Bhagrath, R
  • Awake tracheal intubation in a suspected COVID‐19 patient with critical airway obstruction
    Ahmad, I; Wade, S; Langdon, A; Chamarette, H; Walsh, M; Surda, P
  • Airway obstruction during general anaesthesia in a patient with a vagal nerve stimulator
    Gibbins, M; Quader, K; Watson, G; Pichierri, A
  • Tracheal resection: the team brief in multi‐stage airway surgery
    Cervi, E; Ong, C
  • Unexpected difficult airway management in a transgender female patient
    Vowles, B; Ahmad, I; Christodoulides, G
  • A transglottic foreign body in the airway of an infant
    Sharma, R; Singh, R
  • A junior doctor’s experience of critical illness: from treating patients to becoming a patient with COVID‐19
    Ramachandran, S