Emergency dental management of a child with epidermolysis bullosa under general anesthesia - A case report

Motor activity during general anesthesia (GA) without curarization is often interpreted as reflecting insufficient analgosedation. Here we present the case of an octogenarian scheduled for deep sclerectomy receiving opioid-sparing electroencephalography-(EEG)-guided anesthesia. Periodic Leg Movements (PLM) made their appearance with ongoing surgery while his raw EEG displayed a pattern of deep GA (burst suppression). To the best of our knowledge, this is the first description of actimetry-documented persisting PLM during EEG-monitored GA. Recognizing PLM in the context of GA is of importance for anesthesiologists, as increasing sedation may increase motor activity.

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Multi-Level Lower Extremity Arterial Revascularization Via Retrograde Pedal Access Under Local Anesthesia in a Patient With Severe Cardiopulmonary Comorbidities: A Case Report

Vascular and Endovascular Surgery ◽

10.1177/15385744211026451 ◽

2021 ◽

pp. 153857442110264

Author(s):

Hee Korleski ◽

Laura DiChiacchio ◽

Luiz Araujo ◽

Michael R. Hall

Keyword(s):

Case Report ◽

General Anesthesia ◽

Peripheral Artery Disease ◽

Critical Limb Ischemia ◽

Treatment Modality ◽

Conventional Treatment ◽

Limb Ischemia ◽

Peripheral Artery ◽

Endovascular Revascularization ◽

Artery Disease

Background: Chronic limb-threatening ischemia is a severe form of peripheral artery disease that leads to high rates of amputation and mortality if left untreated. Bypass surgery and antegrade endovascular revascularization through femoral artery access from either side are accepted as conventional treatment modalities for critical limb ischemia. The retrograde pedal access revascularization is an alternative treatment modality useful in specific clinical scenarios; however, these indications have not been well described in literature. This case report highlights the use of retrograde pedal access approach as primary treatment modality in a patient with an extensive comorbidities precluding general anesthesia nor supine positioning. Case Presentation: The patient is a 60-year-old female with multiple severe cardiopulmonary comorbidities presenting with dry gangrene of the right great toe. Her comorbidities and inability to tolerate supine positioning precluded her from receiving open surgery, general anesthesia or monitored sedation, or percutaneous femoral access. Rather, the patient underwent ankle block and retrograde endovascular revascularization via dorsalis pedis artery access without post-operative complications. Discussion: The prevalence of comorbidities related to peripheral artery disease is increasing and with it the number of patients who are not optimal candidates for conventional treatment methods for critical limb ischemia. The retrograde pedal access revascularization as initial treatment modality offers these patients an alternative limb salvaging treatment option.

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