Unveiling what is absent within: illustrating anesthetic considerations in a patient with hydranencephaly - a case report.

BACKGROUND: Hydranencephaly is a rare and debilitating congenital condition in which most anesthesiologists are unfamiliar. Primary surgical treatment involves CSF diversion, though other palliative procedures requiring anesthesia are often required. With medical advancements and a resulting prolonged life expectancy, caring for these patients is becoming more routine. CASE PRESENTATION: We follow an infant with hydranencephaly over three different procedures requiring anesthesia from 5 months of age to 2 years, highlighting the various anesthetic considerations. CONCLUSIONS: Anticipation of difficult positioning, deliberate airway management, and attention to anesthetic recovery were all necessary to safely care for this patient. An understanding of the challenges this particular condition poses will help anesthesiologists provide the most safe and effective care when encountering these patients.

Hitting the Nail on the Head: A Case Report Demonstrating the Importance of a Multidisciplinary Approach to an Unusual Penetrating Intracranial Injury.

A 28-year-old man presented with a penetrating injury by a nail gun to the head. Imaging revealed a nail abutting the superior sagittal sinus without active extravasation. An anesthesia-led multidisciplinary team devised a detailed perioperative plan including conception of a complex decision tree, coordination of care, and resource utilization. In the operating room, the nail was removed under general anesthesia, with blood products and equipment for craniotomy readily available, and imaging modalities reserved for immediate use. This case highlights the importance of a multidisciplinary approach to challenging penetrating head injuries and the crucial role anesthesiologists have as leaders in perioperative care.

Temporal reward discounting in children, adolescents, and emerging adults during an experiential task.

The goal of this study was to examine age effects on the ability/willingness to wait for large rewards in a real temporal reward discounting task from childhood to adulthood. Therefore, a real temporal discounting (TD) task was administered to children aged 6-12 (n = 39), adolescents aged 13-17 (n = 28), and young adults aged 18-19 (n = 55). Findings indicated that the cross-sectional development of TD followed a quadratic pattern across age groups, with adolescents choosing more often than children and adults to wait for the large delayed reward, resulting in reward-maximization. Various interpretations of this finding were offered, including a focus on reward maximization despite an immature ability to exert self-control, and flexible self-control which was high during this task as a result of strong motivation to maximize financial gains.