ABSTRACT
Extracorporeal membrane oxygenation (ECMO) provides a bypass of the lungs, ensuring blood oxygenation and carbon dioxide removal in cases of respiratory failure. The nature of the device itself creates many perioperative challenges, including fluid management and the management of anticoagulation. Surgery via the posterior approach for an unstable spinal fracture requiring the ventral decubitus position comes with its own set of difficulties, among which are the need for stability and craniocaudal alignment when rotating the patient, the risk of increased abdominal pressure, and the damage to vulnerable soft tissues like the eyes, nose, and others. The combination of these two situations creates a synergistic effect, which adds to the difficulty of the management of the situation and requires a personalized, multidisciplinary approach. We present a case of a critical trauma patient who was on venovenous ECMO as a consequence of refractory respiratory hypoxemia with an unstable mid-thoracic spinal fracture requiring surgical intervention via the posterior approach (demanding intra-operative ventral decubitus).
ABSTRACT
Ondansetron is commonly used during the peri-operative period for the prophylaxis of postoperative nausea and vomiting (PONV). It is a 5-hydroxytryptamine 3 (5-HT3) receptor antagonist. Although relatively safe, few cases of ondansetron-induced bradycardia are described in the literature. Here, we present the case of a 41-year-old female with a burst fracture of the lumbar (L2) vertebrae following a fall from height. The patient underwent spinal fixation in the prone position. The intra-operative period was otherwise uneventful, except for an unprecedented incidence of bradycardia and hypotension following administration of intravenous (IV) ondansetron, at the time of closure of the surgical wound site. It was managed with IV atropine and fluid bolus. The patient was shifted to a intensive care unit (ICU) postoperatively. The postoperative period was uneventful, and the patient was discharged in good health on postoperative day three.
ABSTRACT
Myasthenia gravis (MG) is a neurological disorder involving the post-synaptic neuromuscular junction and is caused by the autoimmune destruction of acetylcholine receptors with ensuing muscular weakness. Rarely is the disease process in MG compounded with other comorbidities and distinctive surgical challenges, such as the prone position in spine surgery, presenting unique challenges in the anesthetic management of such cases. This case series and the ensuing discussion describe the successful perioperative management of two cases of MG undergoing neuro-surgical management for lumbar spine pathologies.
Subject(s)
Chronic Pain , Chronic Pain/therapy , Humans , Lumbar Vertebrae , Patient Positioning , Prone PositionABSTRACT
Posterior cranial fossa tumors are the most common neuro-oncological pathology of childhood. More than half of them are located along the midline, occupying the cerebellar vermis and 4th ventricle cavity. Historically, most of these tumors were operated on with the patient in sitting position. This tendency has significantly changed in the last 30 years. For example, 95% of all operations in Japan are now performed with the patient in lying position; for the US and Europe, these figures are 80 and 60%, respectively. This global tendency of switching to the lying position is mainly associated with a high risk of venous air embolism in the sitting position. In the period between 1999 and 2013, the first author used only the sitting position for resection of PCF tumors. During this period, he performed 606 operations. In patients with large/giant tumors (usually, these were piloid astrocytomas with cysts), the surgeon often faced the problem of excessive retraction of the cerebellum and rupture of the bridging veins, sometimes outside the surgical approach area. This situation led either to massive blood loss or to venous air embolism. MATERIAL AND METHODS: Therefore, beginning at 2013, we started to selectively use the prone position in cases of hemispheric piloid astrocytomas of the cerebellum. This initial experience allowed us to assess the surgical features of the procedure and use the experience in more complex interventions. Since the middle of 2016, given the tendency of using key-hole approaches, we have increasingly used the prone position in surgery of PCF tumors, sometimes removing tumors even through the burr hole. Since the end of 2016, we have routinely used the prone position for various tumors of the 4th ventricle. Between November 2016 and September 2017, the first author performed 113 surgeries for PCF tumors in children; of these, only 4 operations were performed in the sitting position. Thus, in less than a year, the prone position has become the main one in surgery for all PCF tumors in our practice. In this article, we would like to share our practical suggestions both about using the prone position and about its advantages and disadvantages that should be considered by a doctor who does not have experience of PCF surgery with the patient in prone position.
Subject(s)
Brain Neoplasms , Cranial Fossa, Posterior , Cerebellum , Child , Humans , Patient Positioning , Posture , Prone PositionABSTRACT
Objective To develop an integrated prone position cushion to facilitate the operation and nursing of the patient.Methods The cushion was composed of outer and inner layers with considerations on gender and operative sites.The inner layer was made of plus hard high-density sponge,the outer layer was manufactured with polyurethane (PU),and the two layers were connected by Velcro.Results The cushion behaved well in shock proof and buffering,which could expose the operative field sufficiently and decrease the incidence rate of pressure sore during the operation.Conclusion The cushion gains advantages in simple structure,stability,safety,easy operation and disinfection,and is applicable for prone position surgery.
ABSTRACT
Objective To develop an integrated prone position cushion to facilitate the operation and nursing of the patient.Methods The cushion was composed of outer and inner layers with considerations on gender and operative sites.The inner layer was made of plus hard high-density sponge,the outer layer was manufactured with polyurethane (PU),and the two layers were connected by Velcro.Results The cushion behaved well in shock proof and buffering,which could expose the operative field sufficiently and decrease the incidence rate of pressure sore during the operation.Conclusion The cushion gains advantages in simple structure,stability,safety,easy operation and disinfection,and is applicable for prone position surgery.
