ABSTRACT
Stiff-person syndrome is a progressive disease of muscle rigidity and spasticity due to a deficiency in the production of γ-aminobutyric acid. Because of the rarity of the condition, little is known about effects of anesthesia on patients with stiff-person syndrome. This report describes the clinical course for a single patient with stiff-person syndrome who received general anesthesia on 3 separate occasions. Her anesthetics included use of both neuromuscular blockade and volatile agents. Unlike several previous reports regarding anesthesia and stiff-person syndrome, the postoperative period for this patient did not require prolonged intubation or result in any residual weakness.
Subject(s)
Anesthesia, General/methods , Anesthetics, Inhalation , Anesthetics, Intravenous , Neuromuscular Blockade/methods , Neuromuscular Nondepolarizing Agents , Stiff-Person Syndrome/surgery , Androstanols , Female , Fentanyl , Humans , Methyl Ethers , Middle Aged , Propofol , Rocuronium , SevofluraneSubject(s)
Carotid Artery Injuries/diagnostic imaging , Carotid Artery Injuries/etiology , Catheterization, Central Venous/adverse effects , Ultrasonography/methods , Video Recording/methods , Wounds, Penetrating/diagnostic imaging , Wounds, Penetrating/etiology , Adolescent , Aged , Female , Humans , Male , Middle Aged , Ultrasonography, Interventional/adverse effectsSubject(s)
Arteries/injuries , Catheterization, Central Venous/methods , Manometry , Medical Errors/prevention & control , Wounds, Penetrating/prevention & control , Catheterization, Central Venous/adverse effects , Catheterization, Central Venous/instrumentation , Equipment Design , Humans , Manometry/instrumentation , Wounds, Penetrating/etiologyABSTRACT
BACKGROUND: Unintended arterial puncture occurs in 2%-4.5% of central venous catheterizations, resulting in arterial injury in 0.1%-0.5% of patients. Routine performance of manometry during catheterization may successfully identify unintended arterial puncture and avoid arterial cannulation and injury. METHODS: We conducted a retrospective review of all cases of central venous catheter placement during a 15-yr period after implementation of a safety program requiring mandatory use of manometry to verify venous access. Arterial injuries were defined as unintended arterial cannulations with a 7-French or larger catheter or dilator. Arterial punctures were defined as the unintended placement of an 18-gauge catheter or needle into the artery. Data were reviewed for all arterial injuries during the entire 15-yr period. In addition, data on both arterial puncture and subsequent arterial injury were evaluated during the final year of analysis. RESULTS: A total of 9348 central venous catheters were placed during the observation period. During the full 15 yr of observation, there were no cases of arterial injury. During the final year of assessment, 511 central venous catheters were placed, with arterial punctures in 28 patients (5%). Arterial puncture was recognized without manometry in 24 cases. Arterial puncture was identified only with manometry in 4 cases, with no incidents of arterial injury. CONCLUSIONS: Consistent use of manometry, to verify venous placement, during central venous catheterization effectively eliminated arterial injury from unintended arterial cannulation during the 15-yr assessment.
