Tag Diana Ayubcha

Valproate

Uses Most widely prescribed antiepileptic drug worldwide. Used in treatment of epilepsy, acute mania, bipolar disease, impulse-control disorders, migraine headaches, and neuropathic pain. Perioperative Risks Hemorrhage Platelet dysfunction Coagulopathy Hyperammonemic encephalopathy Seizures with subtherapeutic plasma concentration Worry About Decreased factor…

Myoclonic Epilepsy With Ragged Red Fibers

Risk Prevalence: 1:400,000 Maternal inheritance; less commonly a spontaneous mitochondrial gene mutation in those without family Hx Perioperative Risks Lactic acidosis Cardiac/respiratory insufficiency/failure Delayed emergence Worry About Respiratory failure following sedation. Consider aspiration risk. Lactic acidosis. Seizures. Overview Mitochondrial myopathy…

Perioperative Cardiac Risk Assessment in Noncardiac Surgery

Introduction Anesthesia has become increasingly safer. According to the Anesthesia Quality Institute’s National Anesthesia Clinical Outcomes Registry, comprising over 30 million cases, perioperative mortality has significantly decreased in high-income countries despite a population increasingly burdened by severe comorbidities. Nevertheless, cardiac…

Perioperative Hypoxia

Case Synopsis A 42-year-old, 70-inch-tall, 95-kg man with chronic obstructive pulmonary disease and hypertension is undergoing a laparoscopic appendectomy. A satisfactory rapid-sequence induction with propofol and succinylcholine is performed, appropriate antibiotics are administered, and the abdomen is insufflated. Fifteen minutes…

Posterior Fossa Surgery

Case Synopsis A 53-year-old woman undergoes posterior fossa craniotomy for removal of a right acoustic schwannoma. Preoperative symptoms included tinnitus, episodic vertigo, headache, facial asymmetry, and loss of coordination and balance. The surgeon will use a retrosigmoid approach and is…

Complications of Spinal Surgery

Case Synopsis A 78-year-old man with morbid obesity (body mass index [BMI] 43), chronic atrial fibrillation on dabigatran (discontinued 5 days prior), and metastatic renal cell carcinoma to T8 is undergoing corpectomy and multilevel instrumented fusion using propofol-based total intravenous…