Postdural puncture headache(PDPH)is an incapacitating complication that can occur following spinal anesthesia and with inadvertent dural puncture during epidural anesthesia.We present a case of a 32-year-old G2 P1 fem...Postdural puncture headache(PDPH)is an incapacitating complication that can occur following spinal anesthesia and with inadvertent dural puncture during epidural anesthesia.We present a case of a 32-year-old G2 P1 female who was admitted for induction of labor and received epidural catheter placement for analgesia.After an inadvertent dural puncture and development of a PDPH,the patient was offered conservative measures for the first 48 hours without improvement.An epidural blood patch(EBP)was placed achieving only moderate relief.Two days later,a second EBP was performed and the patient developed severe back pain which radiated bilaterally to her buttocks.Magnetic resonance imaging(MRI)demonstrated the presence of blood in the intrathecal space.This could be the cause of sacral radiculitis,an uncommon complication of an EBP.This suggests that EBPs could potentially cause neurologic symptoms which may be more common than people previously thought.As complicated outcomes have followed both conservative and aggressive management,MRI can be an early diagnostic tool in such cases and a multidisciplinary approach should be taken.展开更多
Mast cell activation syndrome(MCAS)includes a group of disorders that result in the inappropriate release of inflammatory mediators from mast cells.These mediators can affect multiple organ systems and lead to signifi...Mast cell activation syndrome(MCAS)includes a group of disorders that result in the inappropriate release of inflammatory mediators from mast cells.These mediators can affect multiple organ systems and lead to significant morbidity,and possible fatality.Although reactions,typically in response to various nonspecific stimuli,are usually mild,they may put those with MCAS at increased risk of anaphylaxis.In this case report,we present two clinical scenarios of MCAS,and identify possible factors triggering mast cell mediator release.We also define a preoperative preventive pathway,outline anesthetic considerations,and discuss the management of immediate hypersensitivity reactions in patients with MCAS.Meticulous preoperative preparation,avoidance of triggers,and development of a plan to treat possible adverse organ responses are paramount of good outcomes.展开更多
基金supported in part by the University of California Davis Health Department of Anesthesiology and Pain MedicineNIH grant UL1 TR001860 of the University of California Davis Health。
文摘Postdural puncture headache(PDPH)is an incapacitating complication that can occur following spinal anesthesia and with inadvertent dural puncture during epidural anesthesia.We present a case of a 32-year-old G2 P1 female who was admitted for induction of labor and received epidural catheter placement for analgesia.After an inadvertent dural puncture and development of a PDPH,the patient was offered conservative measures for the first 48 hours without improvement.An epidural blood patch(EBP)was placed achieving only moderate relief.Two days later,a second EBP was performed and the patient developed severe back pain which radiated bilaterally to her buttocks.Magnetic resonance imaging(MRI)demonstrated the presence of blood in the intrathecal space.This could be the cause of sacral radiculitis,an uncommon complication of an EBP.This suggests that EBPs could potentially cause neurologic symptoms which may be more common than people previously thought.As complicated outcomes have followed both conservative and aggressive management,MRI can be an early diagnostic tool in such cases and a multidisciplinary approach should be taken.
基金supported in part by the Department of Anesthesiology and Pain Medicine of University of California Davis Health and NIH grant UL1TR000002 to the University of California Davis Health
文摘Mast cell activation syndrome(MCAS)includes a group of disorders that result in the inappropriate release of inflammatory mediators from mast cells.These mediators can affect multiple organ systems and lead to significant morbidity,and possible fatality.Although reactions,typically in response to various nonspecific stimuli,are usually mild,they may put those with MCAS at increased risk of anaphylaxis.In this case report,we present two clinical scenarios of MCAS,and identify possible factors triggering mast cell mediator release.We also define a preoperative preventive pathway,outline anesthetic considerations,and discuss the management of immediate hypersensitivity reactions in patients with MCAS.Meticulous preoperative preparation,avoidance of triggers,and development of a plan to treat possible adverse organ responses are paramount of good outcomes.
