A 2-month and 13-day-old boy underwent surgery for a right inguinal hernia. During the procedure, a caudal block was performed using 4 mL of 0.25% bupivacaine injected with an epinephrine-soaked syringe. Before the injection, we confirmed that there was no blood or cerebrospinal fluid present. However, shortly after the injection, the patient experienced respiratory apnea and a slow heart rate. The medical team provided respiratory and cardiac support and closely monitored the patient. After a day and a half, the patient was discharged with no further complications.

Background: Foreign body aspiration is common in children and poses a significant risk of morbidity and mortality. Rigid bronchoscopy is the most common method for removing aspirated foreign bodies.Objectives: Anesthesiologists play a critical role in managing these procedures, aiming to find the best strategies with the fewest complications. This study aims to compare anesthesia-related complications during rigid bronchoscopy in children using muscle relaxants versus no muscle relaxants. Methods: In this clinical trial, 60 eligible children were randomly divided into three equal groups: SP: Spontaneous ventilation with sevoflurane and propofol; VA: Controlled ventilation with sevoflurane and atracurium; VR: Controlled ventilation with sevoflurane and rocuronium. At the end of anesthesia, complications such as cough, bucking, hypoxemia, laryngospasm, and bronchospasm were compared, along with the pulmonologist’s level of satisfaction, surgery duration, and total anesthesia time in the three groups. Results: The comparison between the SP, VR, and VA groups revealed the following: No significant difference was found in the incidence of cough and respiratory distress following foreign body aspiration among the three groups (P = 0.262 and P = 0.762, respectively); minimum oxygen saturation during rigid bronchoscopy differed significantly between the groups (P = 0.013); bucking during bronchoscopy was significantly more frequent in the SP group (P = 0.017); laryngospasm was significantly more common in the SP group compared to the other two groups (P = 0.004); agitation during recovery was significantly lower in the propofol (SP) group; pulmonologist satisfaction was highest in the VR group, followed by the VA group, with a significant difference compared to the SP group (P = 0.021); although the SP group experienced more frequent hypoxemia, the difference was not statistically significant; there was no significant difference in anesthesia or bronchoscopy duration across the three groups. Conclusions: The study results suggest that using muscle relaxants in rigid bronchoscopy offers several advantages, including fewer intraoperative complications such as bucking and laryngospasm. Additionally, controlled ventilation reduced the need for intravenous anesthetics and opioids, minimizing adverse effects and shortening recovery times.

Paresthesia is described as a burning or prickling sensation or partial numbness caused by neurologic injury. The sensory loss may be the result of a reversible and/or irreversible nerve damage, and it can be caused by local or systemic factors. Local factors include traumatic injuries caused by impacted teeth, local injection, endodontic therapy, implant placement and exposure to toxic materials. This article reports a paresthesia by anesthetic injection. A 44-year-old man reported moderate pain during chewing and exposure to cold. Upon clinical examination, extension of the tooth fracture line was in the mesiodistal region of the mandibular left second premolar crown and was detected with 16× magnification of microscope. The diagnosis was cracked tooth syndrome, and root canal treatment was indicated. After the first appointment the patient reported altered sensation on left side of mandible, numbness and electric shock sensation, and therefore was diagnosed with mental nerve paresthesia. Diclofenac sodium, thiamine, cyanocobalamin, and pyridoxine were prescribed for 7 days as part of the treatment, and then root canal and restorative treatments were completed. Patient was scheduled for follow-up appointments after 1, 3, 6, and 8 months. After the first month, the feeling of paresthesia was still present and the patient was experiencing a painful “electric shock”. At the 8-month follow-up visit, the paresthesia had been resolved with return of normal sensation.

Background: Transient neurological symptoms (TNS), was described in patients recovering from spinal anesthesia with lidocaine but its etiology remains unknown this study was evaluated the influence of ambulation time on the occurrence of TNSs after spinal anesthesia with lidocaine 5%.Materials and Methods: This randomized clinical trial was conducted on 60 patients with American Society of Anesthesiologists Grades I and II, who were candidates for lower abdominal surgery in supine or lithotomy positions. Patients were randomly divided into early ambulation group (Group A) who were asked to start walking as soon as the anesthesia was diminished or to the late ambulation group (Group B) who walked after at least 12 h bedridden. Participants were contacted 2 days after spinal anesthesia to assess any type of pain at surgical or anesthesia injection site, muscle weakness, fatigue, vertigo, nausea, vomiting, headache, and difficult urination or defecation.Results: Four subjects (13.3%) in Group A and two patients (6.7%) in Group B had pain at anesthesia injection site (P=0.019). Fourteen patients in Group A (46.7%) and six patients in Group B (20%) had post-dural puncture headache (P=0.014). Participants in Group B reported difficult urination more than Group A (P=0.002). there were not statistically significant differences between two groups regarding frequency of fatigue, muscle weakness, vertigo, nausea, vomiting, difficult defecation, paresthesia, and the mean of visual analogue scale at the surgical site.Conclusion: Early ambulation after spinal anesthesia with lidocaine did not increase the risk of neurologic complication.

Background: Diabetes mellitus (DM) is risk factor for complications after orthopedic surgery.Objectives: We tested the hypothesis that anesthesia preoperative clinic (APC) referral for elevated glycosylated hemoglobin (HbA1c) reduces complication rate after total joint arthroplasty (TJA).Patients and Methods: Patients (n=203) with and without DM were chosen from 1,237 patients undergoing TJA during 2006-12. Patients evaluated in the APC had surgery in 2006-8 regardless of HbA1c (uncontrolled). Those evaluated between in subsequent two-year intervals were referred to primary care for HbA1c ≥10% and ≥8%, respectively, to improve DM control before surgery. Complications and mortality were quantified postoperatively and at three, six, and twelve months. Length of stay (LOS) and patients requiring a prolonged LOS (> 5 days) were recorded.Results: Patients (197 men, 6 women) underwent 71, 131, and 1 total hip, knee, and shoulder replacements, respectively. Patients undergoing TJA with uncontrolled HbA1c and those with HbA1c <10%, but not those with HbA1c <8%, had a higher incidence of coronary disease and hypercholesterolemia than patients without DM. An increase in complication rate was observed in DM patients with uncontrolled HbA1c versus patients without DM (P<0.001); the complication rate progressively decreased with tighter HbA1c control. More DM patients with preoperative HbA1c that was uncontrolled or ≥10% required prolonged LOS versus those without DM (P<0.001 and P=0.0404, respectively).Conclusions: APC referral for elevated HbA1c reduces complication rate and the incidence of prolonged hospitalization during the first year after surgery in diabetics undergoing TJA.

The analysis of complaints in different fields of medicine helps understand medical malpractices. This study investigated the complaints related to anesthesia services raised in Kermanshah Medical Council. A total of 35 complaints were found, among which were 16 cases of death and eight cases concluded the malpractice of anesthesiologist. In 21% of cases, the anesthesiologist was found guilty. About half of the complaints and confirmed cases of malpractices pertained to death or permanent brain damage.