RESUMO
Amyotrophic lateral sclerosis (ALS) is a progressive form of neurological disorder that affects both the upper and lower motor neurons. Anesthesia management in these patients is always challenging as they can develop respiratory complications because of pre-existing muscle involvement. We report a middle-aged male with ALS posted for chronic subdural hematoma evacuation (CSDH) surgery. Surgery was done under scalp block with monitored anesthesia care. The choice of anesthesia in these patients should be one that interferes the least with the disease pattern while still providing optimal conditions for surgery.
RESUMO
Enhanced Recovery After Surgery (ERAS) protocols have revolutionized the approach to perioperative care in various surgical specialties. They reduce complications, improve patient outcomes, and shorten hospital lengths of stay. Implementation of ERAS protocols for neurosurgical procedures has been relatively underexplored and underutilized due to the unique challenges and complexities of neurosurgery. This narrative review explores the barriers to, and pioneering strategies of, standardized procedure-specific ERAS protocols, and the importance of multidisciplinary collaboration in neurosurgery and neuroanesthsia, patient-centered approaches, and continuous quality improvement initiatives, to achieve better patient outcomes. It also discusses initiatives to guide future clinical practice, research, and guideline creation, to foster the development of tailored ERAS protocols in neurosurgery.
RESUMO
Transverse myelitis is a rare inflammatory condition typically presenting with symptoms like muscle weakness, sensory issues, and problems affecting bowel and bladder function. In this study, we describe the successful anesthesia management of an adult patient with transverse myelitis exhibiting spastic paralysis and compromised cardiopulmonary reserves, whose preferred resting position was lateral decubitus. Targeted anesthesia was administered via a supraclavicular approach to the brachial plexus block for wrist deformity fixation surgery, mitigating the pulmonary complications associated with general anesthesia, achieving earlier recovery, and avoiding the use of opioids. This case underscores the significance of customizing the patient's personalized positioning, while also highlighting the potential for effective regional anesthesia in atypical positions. We illustrate the successful use of supraclavicular brachial plexus block for left wrist deformity fixation and debridement surgery in the lateral decubitus, the most convenient position for the transverse myelitis patient with spastic paraplegia.
