2017

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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This case report describes the rare occurrence of tetraplegia, caused by conversion disorder, in a patient who received spinal anesthesia for arthroscopic surgery. A 35-year-old female with a history of migraine headaches received spinal anesthesia for arthroscopic left knee surgery. On sensory block examination, she was noted to have a T10 level of blockade. During surgery and45 min after performing spinal anesthesia, patient reported bilateral loss of both sensation and motor function of her upper limbs. Patient was hemodynamic stable with absence of respiratory depression or any alteration of consciousness level. Physical signs and symptoms did not correlate with any known anatomical or neurological patterns. MRI imaging revealed no abnormalities. Psychiatric consultation was performed wherein familial stressor circumstances were identified, leading to diagnosis of conversion disorder.

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