Kinking of Flow Diverter in a Giant Wide-Necked Supraclinoid Internal Carotid Artery Aneurysm / 신경중재치료의학

We report here a rare complication in the form of kinking of flow diverter in a case of giant wide-necked supraclinoid internal carotid artery (ICA) aneurysm 48 hours after the procedure. This 28-year female presented with giant wide-necked right supraclinoid ICA aneurysm which was managed by flow diversion. On 2nd post-op day, patient developed weakness of left side with altered sensorium - angiography and CT showed kinking of flow diverter at the neck of the aneurysm with poor distal flow. Eventually, the patient developed right middle cerebral artery infarct for which decompressive hemicraniectomy was done. The likely cause of development of kink is because the aneurysm was wide-necked, the hemodynamic forces have resulted in inward buckling of the flow diverter at the aneurysm neck. This case shows that kinking of flow diverter can still happen 48 hours post-procedure.

prospective, randomized, controlled trial study of comparison of two techniques for laryngeal mask airway insertion

In this study we compared the use of an intravenous propofol/propofol auto-co-induction technique to propofol/midazolam for laryngeal mask insertion. We also studied the incidence of undesirable effects in relation to LMA insertion. In this prospective, randomized, controlled trial study, 60 adults belonging to ASA class 1 and 2 were randomly divided in three groups; Groupl- Saline-propofol; Group 2- Propofol-midazolam; Group 3-Propofol-propofol. The induction characteristics reviewing various parameters like the induction dose required, hemodynamic changes and the cost of induction were observed. Hemodynamic variables including heart rate [HR], systolic blood pressure [SBP], diastolic blood pressure [DBP], and mean arterial pressure [MAP] were recorded at 2, 4 and 6 minutes post induction. We noticed a decrease in HR, SBP, and DBP and MAP in all 3 groups which was not statistically significant. The total induction dose of propofol in Group 2 [106.3 +/- 21.26 mg] and Group 3 [136.50 +/- 20.29 mg] was significantly lower than Group 1 [1 59.75 +31 .39 mg] but not statistically different between group 2 and 3. The total cost of induction was significantly reduced in the midazolam co-induction group i.e. Group 2. The number of patients suffering from apnea differed significantly between 3 groups i.e. 12 patients in Group 1, 6 patients in Group 2 and 1 patient in Group 3. No significant difference was seen in 3 groups in incidence of hiccups, excitatory phenomenon or laryngospasm. Propofol co-induction [Group 2] and propofol auto co-induction is safe alternative to propofol induction and is more cost effective as they decrease the cost of induction. Midazolam co-induction is more economical than propofol auto co-induction

Drainage of Ludwig's angina in a pregnant patient under superficial cervical plexus block

Ludwig's angina is rapidly spreading cellulitis that may result in potentially lethal upper airway obstruction. There is very little published literature regarding this condition in the pregnant patient. We present a case report of a 20 years old female patient admitted at 30 weeks gestation with tooth pain, submandibular swelling, severe trismus and dysphagia, consistent with Ludwig's angina. Her planned treatment included incision and drainage of associated spaces, teeth extraction, and antibiotic therapy. During a life threatening infectious condition such as the one we describe, risks to the mother and the baby include septicemia, hypoxia and/or asphyxia. We successfully relieved airway obstruction by surgical decompression alone, using a cervical plexus block

Stroke from Delayed Embolization of Polymerized Glue Following Percutaneous Direct Injection of a Carotid Body Tumor

A 52-year-old male with right carotid body tumor underwent direct percutaneous glue (n-butylcyanoacrylate [NBCA]) embolization. Several hours later, he developed left hemiparesis from embolization of the polymerized glue cast. Migration of glue during percutaneous tumor embolization is presumed to occur only in the liquid state, which may lead to stroke or cranial nerve deficits. To the best of our knowledge, this is the first report of delayed glue embolization from a treated hypervascular tumor of the head and neck.