BACKGROUND Posterior reversible encephalopathy syndrome (PRES) is a neuroradiological condition commonly associated with hypertensive disorders of pregnancy, including preeclampsia, eclampsia, and hemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. Although PRES is generally considered reversible after prompt treatment, atypical and hemorrhagic variants may rapidly progress toward irreversible neurological injury and death. CASE SUMMARY A 33-year-old woman at 37 weeks of gestation was admitted with severe hypertension, headache, and abdominal pain. Laboratory findings were consistent with HELLP syndrome, prompting urgent cesarean delivery. Shortly after surgery, the patient developed recurrent visual disturbances, cortical blindness, confusion, and generalized seizures. Brain magnetic resonance imaging demonstrated extensive bilateral cortico-subcortical hyperintensities involving the parieto-occipital regions, basal ganglia, posterior cingulate cortex, pons, cerebellum, and splenium of the corpus callosum, consistent with atypical PRES. The patient developed hemorrhagic transformation, diffuse cerebral edema and then brain death, despite the early intensive treatment by magnesium sulfate, antihypertensive therapy, mechanical ventilation, antiepileptic treatment, osmotherapy and platelet transfusion. CONCLUSION Hemorrhagic central PRES associated with HELLP syndrome may rapidly evolve toward fatal neurological injury despite early diagnosis and treatment.
BACKGROUND Osteonecrosis or avascular necrosis (AVN) of the hip was one of the dreaded complications of coronavirus disease 2019 (COVID-19), which emerged in patients who received steroid therapy. Corticosteroids have been a mainstay in the treatment protocol of COVID-19 patients. Popular corticosteroid drugs used in patients suffering from COVID-19 were intravenous (IV) or oral dexamethasone, methylprednisolone or hydrocortisone. The use of such high doses of corticosteroids has shown very positive results and has been lifesaving in many cases. Still, long-term consequences were drug-induced diabetes, osteoporosis, Cushing syndrome, muscle wasting, peripheral fat mobilization, AVN, hirsutism, sleep disturbances and poor wound healing. A significant number of young patients were admitted for bilateral total hip replacements (THR) secondary to AVN following steroid use for COVID-19 treatment. AIM To assess the efficacy of bilateral pericapsular end nerve group (PENG) blocks in patients posted for bilateral THR post-steroid therapy after COVID-19 infection and assess the time taken to first ambulate after surgery. METHODS This prospective observational study was conducted between January 2023 and August 2023 at Care Hospitals, Hyderabad, India. Twenty young patients 30-35 years of age who underwent bilateral THR were studied after due consent over 8 months. All the patients received spinal anaesthesia for surgery and bilateral PENG blocks for postoperative analgesia. RESULTS The duration of surgery was 2.5 h on average. Seventeen out of twenty patients (85%) had a Visual Analog Score (VAS) of less than 2 and did not require any supplementation. One patient was removed from the study, as he required re-exploration. The remaining two patients had a VAS of more than 8 and received IV morphine post-operatively as a rescue analgesic drug. Fifteen out of seventeen patients (88.2%) could be mobilized 12 h after the procedure. CONCLUSION Osteonecrosis or AVN of the hip was one of the dreaded complications of COVID-19, which surfaced in patients who received steroid therapy requiring surgical intervention. Bilateral PENG block is an effective technique to provide post-operative analgesia resulting in early mobilization and enhanced recovery after surgery.
BACKGROUND Heart failure is generally regarded as a progressive and irreversible medical condition. The EVAHEART is an implantable left ventricular assist system.CASE SUMMARY We report the anesthesia management of a 56-year-old male patient with dilated cardiomyopathy undergoing an EVAHEART implantation. Transesophageal echocardiography is crucial to ensure the correct positioning of the device and the proper aortic valve outflow. Because the continuous blood flow device functions best under low systemic and pulmonary vascular resistance, milrinone is the preferred drug. Our patient was accompanied by pulmonary hypertension, so during the operation, nitric oxide was used to reduce pulmonary artery pressure.CONCLUSION The cardiac output achieved by the patient with the assistance of EVAHEART can reach 4 L/min, which of course depends on the front load, rear load, and pump speed.
Intraoperative management of liver transplant in a patient with an undiagnosed ventricular septal defect: A case report
