Super refractory status epilepticus in a parturient with preeclampsia undergoing cesarean delivery under spinal anesthesia

Super refractory status epilepticus (SRSE) is a rare but serious neurological emergency. This case report aims to highlight the challenges faced during the diagnosis and management of SRSE in a 36-year-old preeclamptic patient taken for cesarean delivery under spinal anesthesia. The patient developed a seizure episode minutes after administration of intrathecal bupivacaine, necessitating administration of general anesthesia. Postoperatively, SRSE developed which did not respond to multiple anti-epileptics and thiopentone sodium infusion. Although the clinical picture and magnetic resonance imaging findings supported the diagnosis of posterior reversible encephalopathy syndrome, the role of intrathecal bupivacaine in causing SRSE could not be ruled out due to the temporal association of events. The patient had a prolonged and complicated hospital stay and despite a multimodal approach to the treatment, suffered neurological sequelae.

Role of intrauterine instillation of levobupivacaine as a local anaesthetic for outpatient gynaecological procedures: a randomized controlled study

Background: Procedures such as intrauterine device (IUD) insertion and endometrial biopsy, are routinely performed in the outpatient setting for various indications. Satisfactory pain control for women undergoing outpatient gynecological procedures is critical for both patient comfort and procedure success. The perception of pain during gynecological procedures originates from manipulation of the cervix and/or uterus.Methods: This study evaluated the role of intrauterine instillation of 0.5% levobupivacaine as local anesthetic in terms of pain score during and post outpatient gynecological procedures (endometrial aspiration biopsy and IUD insertion), reduction in need for post procedural analgesia and allowance of early return to normal activity. The trial medication was intrauterine anesthesia, either 5 mL 0.5% levobupivacaine or 5 mL 0.9% saline (control group) on 100 patients. Primary outcome was self-reported pain scores on numerical pain scale at various points of procedure, point (0) was a grade for as no pain and the worst pain was graded as ten point (10) in this scale. During the procedure, degree of pain was specified by study subjects at 4 steps. These steps were 1) immediately after tenaculum application, 2) during the solution instillation and 3) IUD insertion or EB and 4) 15 minutes after the procedure and 24 hours later.Results: Pain scores of the intrauterine levobupivacaine groups were found to be significantly lower than the control group also there was reduced need for additional analgesia and also, they had early return to normal activity.Conclusions: Study sought to reduce pain during OPD procedures which might lead to better patient experience, reduce anxiety and produce an overall better outcome.

Posterior fossa oligodendroglioma.

Oligodendroglioma are the tumors of glial cells. They are rare in children and are more common in the cerebral hemispheres. A rare case of infratentorial oligodendroglioma in a female child is being reported here.