This case report focuses on the anesthetic management of a patient with Myasthenia Gravis who underwent left-sided colectomy, due to the presence of a tumor on the left colic (splenic) flexure. Myasthenia gravis is a chronic autoimmune neuromuscular disease which is characterized by differ-ent degrees of weakness of skeletal muscles. The anesthetic management and treatment of every patient with myasthenia gravis should be performed carefully, due to the fact that many periopera-tive complications may occur. In our case anesthetic technique included the combination of general anesthesia, with the use of neuromuscular agent and thoracic epidural blockade with the use of a catheter, which permitted intermittent boluses doses and continuous infusion of local anesthetics and opioids. Neuromuscular blockade was reversed with the use of sugammadex. Patient’s periop-erative management was effective and uneventful.
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We report a case of persistent bronchospasm after anesthesia induction. The case refers to an elective surgery of an ulcerous formation in the intergluteal cleft. Bronchospasm is not an unusual event in the immediate intubation period, especially in patients with respiratory disease, but in most cases resolves uneventfully. In this patient, despite thorough treatment in the operation room, ausculatory findings remained unchanged, with progressive worsening of arterial blood gases. After this event, the surgery was postponed and the patient was transferred to the ICU for further management. In this article we describe the steps that were taken in order to manage this adverse event and ensure patient’s safety and successful outcome.
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Scoliosis is a musculoskeletal disorder, in which there is a sideways curvature of the spine. Surgical correction of scoliosis is a long-lasting high-risk procedure, which can lead to serious complications such as pulmonary embolism and substantial haemorrhage. In our case a 20 year-old male with idiopathic scoliosis curve of 82o underwent a reconstructive spinal surgery. Tranexamic acid (TXA) i.v infusionwas used intraoperatively to reduce the blood loss. The operation took 8h to complete and proceeded well without complications. Afterwards the patient was then transferred to ICU. The third postoperative day he was admitted back to the orthopedic ward. 7h after admission he presented clinical symptoms of pulmonary embolism (PE). The suspicion of a pulmonary embolism was confirmed by an emergency CT pulmonary angiogram. Consequently, the patient was again admitted to the ICU and was treated with LMWH in a therapeutic dose. Three days later he returned back to the orthopedic ward clinically stabilized and with normal ABGs. In this case report the cause and origin of pulmonary embolism was not clear. The patient was treated with chemical thromboprophylaxis (LMWH) from the first postoperative day and yet PE was not prevented.This event contradicts the supposed rarity of PE after correction of AIS surgery. It also results in a controversy over the efficacy of LMWH on reducing the incidence of VTE and over the safety and proper dosing of TXA.
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